Cervicitis: Treatment & Medication

Updated: Aug 3, 2009Print ThisEmail This

Treatment of all causes of cervicitis is medical. Treatment must include the patient's
sexual partners to prevent reinfection. Treatment for infectious causes of cervicitis can be
done presumptively (treatment with azithromycin or doxycycline) or with specific
antibiotic treatment once the etiology is known.
Activity
No sexual activity for 7 days after initiating treatment
No sexual activity until partner has been treated
Medication

Oral antibiotics effectively cure gonorrhea, chlamydia, and T vaginalis infections. Oral
antivirals reduce duration of symptoms, lesions, and viral shedding in the first and
recurrent episodes of genital herpes infections. Initially, topical therapy is used for
symptomatic genital wart removal. Other options include intralesional injection and
surgery.

In April 2007, the Centers for Disease Control and Prevention (CDC) updated treatment
guidelines for gonococcal infection and associated conditions.5 Fluoroquinolone
antibiotics are no longer recommended to treat gonorrhea in the United States. The
recommendation was based on analysis of new data from the CDC’s Gonococcal Isolate
Surveillance Project (GISP). The data from GISP showed the proportion of
fluoroquinolone-resistant gonorrhea (QRNG) cases in heterosexual men reached 6.7%, an
11-fold increase from 0.6% in 2001. The data were published in the April 13, 2007 issue
of the Morbidity and Mortality Weekly Report. This limits treatment of gonorrhea to
drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose).
Fluoroquinolones may be an alternative treatment option for disseminated gonococcal
infection if antimicrobial susceptibility can be documented.

For more information, see the CDC’s Antibiotic-Resistant Gonorrhea Web site or
Updated Gonococcal treatment recommendations (April 2007).
Antibiotics

Therapy must be comprehensive and cover all likely pathogens in the context of this
clinical setting.
Ceftriaxone (Rocephin)

First-line therapy for gonococcal cervicitis. Third-generation cephalosporin with broad-

spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher
efficacy against resistant organisms. Arrests bacterial growth by binding to one or more
penicillin-binding proteins.
Dosing
Interactions
Contraindications
Precautions
Adult

125 mg IM once
Pediatric

Administer as in adults

Cefixime (Suprax)

Third-generation cephalosporin effective in treating gonorrhea. By binding to one or

more of the penicillin-binding proteins, it arrests bacterial cell wall synthesis and inhibits
bacterial growth. This medication is once again available in the United States.
Dosing
Interactions
Contraindications
Precautions
Adult

400 mg PO once
Pediatric

<45 kg: Not established

>45 kg: Administer as in adults

Spectinomycin (Trobicin)

Inhibits protein synthesis in bacterial cells. Site of action is 30S ribosomal subunit and is
structurally different from related aminoglycosides. Use if allergic to penicillin and
quinolones. Alternative regimen for treatment of gonorrhea. Do not use if oropharyngeal
gonorrhea is suspected.
Dosing
Interactions
Contraindications
Precautions
Adult 2 g IM once
Pediatric
<45 kg: 40 mg/kg IM once
>45 kg: Administer as in adults

Azithromycin (Zithromax)

First-line therapy for chlamydia cervicitis. Semisynthetic macrolide antibiotic effective in

treating chlamydia. Treats mild-to-moderate microbial infections.
Dosing
Interactions
Contraindications
Precautions
Adult

1 g PO once
Pediatric

<6 months: Not established

>6 months: Administer as in adults

Doxycycline (Vibramycin)

Long-acting tetracycline derived from oxytetracycline. Effective in treating chlamydia.

Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S
ribosomal subunits of susceptible bacteria.
Dosing
Interactions
Contraindications
Precautions
Adult

100 mg PO bid for 7 d

Pediatric

<8 years: Not recommended

>8 years: Administer as in adults

Erythromycin base (E-Mycin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from

ribosomes, causing RNA-dependent protein synthesis to arrest. Alternative therapy for
chlamydia cervicitis.
Dosing
Interactions
Contraindications
Precautions
Adult 500 mg PO bid for 7 d
Pediatric <12 years: Not established
>12 years: Administer as in adults

Erythromycin ethylsuccinate (E.E.S.)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from

ribosomes, causing RNA-dependent protein synthesis to arrest. Alternative regimen for
chlamydia cervicitis.
Dosing
Interactions
Contraindications
Precautions
Adult

800 mg PO qid for 7 d

Pediatric

<12 years: Not established

>12 years: Administer as in adults

Metronidazole (Flagyl)

Synthetic antibacterial and antiprotozoal agent. First-line therapy for T vaginalis

infections.
Dosing
Interactions
Contraindications
Precautions
Adult

2 g PO once; alternatively, 500 mg PO bid for 7 d

Pediatric

<1 year: 10-30 mg/kg/d PO for 5-8 d

<12 years: 15 mg/kg/d PO in 3 divided doses for 7-10 d
>12 years: Administer as in adults
Antivirals

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually

form a nucleoside triphosphate. These molecules inhibit HSV polymerase with 30-50
times the potency of human alpha-DNA polymerase.

Acyclovir (Zovirax)

Synthetic purine nucleoside analog indicated for genital HSV infections. First episode,
begin treating within 6 d after appearance of first symptoms. If recurrent attack, begin
treating during prodrome or within 1 d after onset of lesions. Suppression requires daily
treatment for 1 y.
Dosing
Interactions
Contraindications
Precautions
Adult

First episode: 400 mg PO tid for 7-10 d; alternatively 200 mg PO 5 times qd for 7-10 d
Recurrent attack: 200 mg PO 5 times qd for 5 d; alternatively 400 mg PO tid for 5 d or
800 mg PO bid for 5 d
Suppression: 400 mg PO bid for 1 y
Pediatric

First episode: 400 mg PO tid for 7-10 d; not to exceed 80 mg/kg/d

Recurrent attack: 400 mg PO tid for 5 d; alternatively, 800 mg PO bid for 5 d; not to
exceed 80 mg/kg/d
>12 years: Administer as in adults

Famciclovir (Famvir)

Prodrug for penciclovir (active moiety) indicated for genital HSV infections. For first
episode, begin treating within 6 d after appearance of first symptoms. For recurrent
attack, begin treating during prodrome or within 1 d after onset of lesions. Suppression
requires daily treatment for 1 y.
Dosing
Interactions
Contraindications
Precautions
Adult

First episode: 250 mg PO tid for 7-10 d

Recurrent attack: 125 mg PO bid for 5 d
Suppression: 250 mg PO bid for 1 y
Pediatric

Not established

Valacyclovir (Valtrex)

Indicated for genital HSV infections. For first episode, begin treating within 6 d after
appearance of first symptoms. For recurrent attack, begin treating during prodrome or
within 1 d after onset of lesions. Suppression requires daily treatment for 1 y.

Adult
First episode: 1 g PO bid for 7-10 d
Recurrent attack: 500 mg PO bid for 5 d
Suppression: 1 g PO qd for 1 y; alternatively, 500 mg PO qd for 1 y or 250 mg PO bid for
1y
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Topical skin products

Indicated for genital/perianal warts.

Imiquimod (Aldara)

Indicated for genital/perianal warts. Induces secretion of interferon alpha and other
cytokines; mechanism of action are unknown. May be more effective in women than in
men.
Dosing
Interactions
Contraindications
Precautions
Adult

Apply to warts qhs 3 times/wk for up to 16 wk, rinse treatment area with soap and water
6-10 h after application
Pediatric

<12 years: Not established

>12 years: Administer as in adults

Podofilox (Condylox)

Topical antimitotic which can be chemically synthesized or purified from plant families
Coniferae and Berberidaceae (eg, species of Juniperus and Podophyllum). Exact
mechanism of action is unknown.
Dosing
Interactions
Contraindications
Precautions
Adult

Apply bid for 3 d, no therapy for 4 d, then repeat up to 4 cycles

Pediatric

Not established

Fluorouracil (Carac, Efudex, Fluoroplex)

Cycle-specific agent that has activity as single agent and has for many years been
combined with biochemical modulator leucovorin. Shown to be effective in adjuvant
setting. Classic antimetabolite anticancer drug with chemical structure similar to
endogenous intermediates or building blocks of DNA or RNA synthesis. 5-FU inhibits
tumor cell growth through at least 3 different mechanisms that ultimately disrupt DNA
synthesis or cellular viability. These effects depend on intracellular conversion of 5-FU
into 5-FdUMP, 5-FUTP, and 5-FdUTP. 5-FdUMP inhibits thymidylate synthase (key
enzyme in DNA synthesis). 5-FUTP is incorporated into RNA and interferes with RNA
processing, and 5-FdUTP is incorporated into DNA, leading to cytotoxic DNA
strandbreaks.
Dosing
Interactions
Contraindications
Precautions
Adult

Apply daily, may use an applicator for urethral warts

Pediatric

Not established

Trichloroacetic acid (Tri-Chlor)

Cauterizes skin, keratin, and other tissues. Although caustic, causes less local irritation
and systemic toxicity than others in the same class. However, response is often
incomplete and recurrence occurs frequently.
Adult Apply to warts and powder with talc or sodium bicarbonate (baking soda) to
remove unreacted acid; may repeat weekly
Pediatric Not established
Antiprotozoal

Alternative therapy for trichomonas infections.

Tinidazole (Fasigyn, Tindamax)

5-nitroimidazole derivative used for susceptible protozoal infections. Nitro group is

reduced by cell extract of Trichomonas. The free nitro radical generated is thought to be
responsible for antiprotozoal activity against T vaginalis. Indicated to treat trichomoniasis
caused by T vaginalis in both males and females.
Adult Individual and sexual partner: 2 g PO once with food
Pediatric <3 years: Not established
>3 years: 50 mg/kg PO qd for 3 d with food, not to exceed 2 g/dose