SYMPTOMS AND SIGNS OF ACUTE CERVICITIS

The primary symptom of acute cervicitis is a purulent vaginal discharge. The appearance of the discharge is variable—often thick and creamy as in gonorrheal infection; foamy and greenish-white as in trichomona! infection; white and curdlike as in candidiasis; and thin and gray as in bacterial vaginosis. Chlamydia infections often produce a purulent discharge from an angry, reddened, congested cervix. The discharge is often indistinguishable from that due to gonorrheal cervicitis and has been characterized as mucopurulent. Other pathogens that have recently been identified as possible causes of cervicitis are Mycoplasma genitalium, HSV-1 and HSV-2, cytomegalovirus, and bacterial vaginosis. Mucopurulent cervicitis, however, may be present in 40-60% of women in whom no infection is identified.
Inspection of the cervix initially infected hy N gonorrhoeae generally reveals an acutely inflamed, edematous cervix with a purulent discharge escaping from the external os. In trichomonal infection, the classic strawberrylike appearance may be visible on the squamous epithelial surface of the portio vaginalis as well as the adjacent vaginal mucosa. In candidiasis, there is likely to be a white cheesy exudate that is difficult to wipe away and, if scraped off, usually leaves punctate hemorrhagic areas. Colposcopic findings of acute cervicitis are those primarily of an altered microangioarchitecture with marked increase in the surface capillaries, which when viewed end-on may show a pattern of diffuse "puncta-tion." Trichomoniasis is typified by characteristic double-hairpin capillaries. The capillary pattern of inflammation should not be confused with that of neoplasia. In an inflammatory process, the colposcopic picture is diffuse with ill-defined margins in contrast with the localized and sharply demarcated vascular changes associated with intraepithelial neoplasia. It should be emphasized that invasive cancers often are secondarily infected, so in addition to the colposcopic changes associated with frank malignancy, those related to inflammation are also present. Colposcopy also readily identifies the fine villiform pattern of cervical ectopy.
Infertility may be a consequence of cervicitis. A thick, glutinous, acidic, pus-laden cervical mucus is noxious to sperm and prevents fertilization.
Vulvar burning and itching may be prominent symptoms. Gonorrheal cervicitis may be accompanied by urethritis with frequency, urgency, and dysuria. If associated with acute salpingitis, the symptoms and signs will be those of pelvic peritonitis. Hyperemia of the infected cervix may be associated with freely bleeding areas. Cervical ooze may account for intermenstrual (often postcoital) spotting. Bleeding commonly occurs due to cervical friability when endocervical smears are obtained.