Etiology of cervicitis: Are there new agents in play?

Background: Considering the changing causative and resistance pattern of agents implicated in sexually transmitted infections (STIs), etiological diagnosis is imperative, especially in countries practicing syndromic management. This study was designed to identify etiological agents associated with cervicitis and to analyze their association with clinical and behavioral profile.

Materials And Methods: Female STI clinic attendees presenting with cervico-vaginal discharge were examined for the presence of cervicitis. Endocervical swabs were collected for gram staining and real-time polymerase chain reaction was performed for various bacterial and viral STI agents in patients presenting with cervical discharge. A vaginal swab was also evaluated for bacterial vaginosis by Nugent's criteria.

Results: Of 64 patients with vaginal discharge, 26.6% and 12.5% patients complained of genital itching and lower abdominal pain, respectively. Mean of 36.6 pus cells/hpf were observed, appreciably greater number in patients with and infections ( 0.0063 and 0.0032, respectively). Pus cells were high (mean 68 pus cells/hpf) in patients with , though this may be attributed to coexisting . Agents isolated from endocervix were 17 (26.6%), 4 (6.3%), HSV1 and 1 each (1.6%), HSV2, 9 (14.1%), 5 (7.8%), 26 (40.6%), (0%), and 11 (17.2%). Bacterial vaginosis was diagnosed in 14 (21.9%) patients. Multiple agents were isolated in 10 (two), 6 (three), 6 (four), and 1 (five) patients. Isolation of and was significantly associated with bacterial vaginosis ( 0.04 and 0.003, respectively). Nonusage of condoms and mental stress predisposed to cervicitis.

Conclusion: We concluded that there are changing etiological patterns of cervicitis. There is need to use tests that detect wider array of organisms, and can replace standard culture methods with molecular assays, to increase the ability to diagnose more number of organisms implicated in cervicitis.