This section provides additional information to guide management in sexual health clinics.
For management of the following conditions please refer to the relevant section:
Registered nurses who have completed core sexual health competencies and are competent in laboratory procedures and specimen collection are able to undertake clinical examination (including bimanual examination), collect specimens and undertake point-of-care tests for patients presenting with uncomplicated vaginal discharge if they have been delegated to do so by the clinical director of the service (see Delegation of clinical practice).
Any person with symptoms attributable to cervicitis receive assessment, management and follow-up.
When to test for cervicitis
Test for cervicitis if a patient presents with:
- abnormal or altered vaginal discharge
- intermenstrual or postcoital bleeding.
Patients with persistent intermenstrual or any postcoital bleeding also need a cervical co-test as part of the diagnostic evaluation. See Cervical screening test (under Clinical examination and specimen collection/procedure/women) for procedure.
Cervicitis is an inflammatory condition of the cervix. It is defined clinically by the presence of cervical ectopy and/or a friable cervix with easily induced bleeding at the cervical os and/or mucopurulent (yellow-coloured) discharge at the cervical os. Cervicitis is not diagnosed on the basis of microscopy alone.
If no on-site microscopy is available, proceed as below with STI tests.
Diagnosis in females Test Site or specimen Consideration Gram stain Endocervical secretions Recommended test at point of care
If >30 polymorphonuclear lymphocytes are detected per high-power field on Gram stain of endocervical secretions and cervical gram-negative intracellular diplococci have been excluded and cervical bleeding/friability/mucopurulent discharge, treat for non-gonococcal cervicitis.
Wet film Vaginal secretions Recommended test at point of care to identify Trichomonas NAAT (Nucleic acid amplification test) for chlamydia, gonorrhoea and Mycoplasma genitaliuma Cervical swab Undertake in all presentations Culture for gonorrhoea Cervical swab (NOT self-collected) Undertake in all presentations. Discard specimen if cervical Gram stain excludes presence of gram-negative intracellular diplococci. NAAT for trichomoniasis Vaginal or Cervical swab Women with sexual partners from outside Australia, Aboriginal women or clinical signs of frothy green discharge or strawberry cervix on examination NAAT for herpes simplex virus and Syphilisb where available Cervical swab Add if ulceration present
Outpatient treatment for non-gonococcal cervicitis Indication Regime Based on clinical provisional diagnosis
if >30 polymorphonuclear lymphocytes are detected per high-power field on Gram stain of muco-purulent endocervical secretions and cervical gram-negative intracellular diplococci have been excluded, treat for non-gonococcal cervicitis
Doxycycline 100mg twice daily orally for 7 days
azithromycin 1 g orally stat (second line where doxycyline contraindicated or where adherence is unlikely)
Where bacterial vaginosis, trichomonas or gonorrhoeal infections are confirmed through Gram stain and/or wet film, treat accordingly.
Where gonorrhoea or Mycoplasma genitalium infection is diagnosed on microscopy, culture and/or NAAT manage as per infection specific protocol regardless of the presence of current symptoms.
Test partner(s) and treat on the basis of the identified pathogen. Waiting for test results is the preferred approach. Indications for presumptive treatment are outlined below.
Indication for presumptive treatment in asymptomatic partners Regime Presumptive treatment to be considered if an ongoing sexual partner is unlikely to return for results, or distance to services is a barrier
Single-dose alternative can be considered where adherence to a course of medication is unlikely
Doxycycline 100mg twice daily for 7 days
azithromycin 1 g single dose orally (second line where doxycyline contraindicated or where adherence is unlikely)
Patient educationAdvise no sex (oral, vaginal or anal) until medication completed and all regular partners have received their results and completed treatment if indicated.
Patient may need to be recalled for additional antimicrobial treatment once aetiology has been confirmed. Review after seven days with speculum and/or bimanual examination as required.
If there has been persistent intermenstrual or postcoital bleeding, or there is any abnormality on the cervical co-test, refer for colposcopy or gynaecological assessment.
All patient consultations including examinations and tests collected are to be documented on the patient’s medical record.
- References and further reading