Gonococcal Cervicitis Management
Diagnostic Considerations
- The Centers for Disease Control and Prevention (CDC) recommends testing for both N. gonorrhoeae and C. trachomatis using nucleic acid amplification tests (NAATs) in women with cervicitis, which are the most sensitive and specific tests available 3, 4, 5, 6
- Assessment for signs of pelvic inflammatory disease (PID) is necessary, as cervicitis may indicate upper genital tract infection 3, 4, 6
- Evaluation for bacterial vaginosis (BV) and trichomoniasis, and treatment if present, is recommended 3, 4, 5, 6
- NAAT can be performed on cervical or urine samples 3, 4, 5, 6
Treatment Regimen
- For uncomplicated gonococcal cervicitis, alternative regimens include cefixime 400 mg orally as a single dose PLUS azithromycin 1 g orally PLUS test-of-cure in 1 week 1, 2
- For patients with severe cephalosporin allergy, azithromycin 2 g orally as a single dose PLUS test-of-cure in 1 week is recommended 1, 2
Partner Management
- Sex partners from the preceding 60 days should be notified, examined, and treated for gonorrhea and chlamydia 3, 4, 5, 6
- Patients and partners should abstain from sexual intercourse until therapy is completed (7 days after single-dose regimen or after completion of 7-day regimen) 3, 4, 5, 6
Special Populations
- HIV-infected women should receive the same treatment regimen as HIV-negative women 3, 4, 5, 6
- Treatment is vital for HIV-infected women because cervicitis increases cervical HIV shedding and may increase HIV transmission 5, 6
Treatment Failure Management
- For persistent infection after recommended treatment, culture relevant clinical specimens and perform antimicrobial susceptibility testing 1, 2
- Consult an infectious disease specialist or CDC, and report the case to CDC through local or state health department within 24 hours 1, 2
- Conduct test-of-cure 1 week after re-treatment, and ensure sex partners from preceding 60 days are evaluated and treated 1, 2