Table 18.1 Nomenclature of bone tumors
Figure 86 Colposcopy of a woman with mucopurulent cervicitis and purulent discharge from endocervical os.
• Carcinoma of the cervix
• Cervical erosion
• Cervical metaplasia
The patient usually presents with a vaginal discharge or history of postcoital bleeding. Otherwise the patient is diagnosed asymptomatically during routine examination. On examination there is gross visualization of yellow, mucopurulent material on the cotton swab.
On a smear there will be ten or more polymorphonuclear leukocytes per microscopic field. Positive Gram stain is found. Cultures should be obtained for Chlamydia and N. gonorrhoeae. Use a wet mount to look for trichomonads. Obtain a Pap smear.
Cervicitis is treated in an outpatient setting. Cryosurgery is an option for treatment of cervicitis with negative cultures and negative biopsies. Safe sex should be practiced with the use of condoms. Partners should be treated in all cases of infection proven by culture.
ACUTE GENERAL Rx
Because Chlamydia and N. gonorrhoeae make up >50% of the cause of infectious cervicitis, if it is suspected, treat without waiting for culture results. Administer ceftriaxone 125-mg IM single dose followed by doxycycline 100 mg PO bid for 7 days. If the patient is pregnant, treat with azithromycin (Zithromax) 1-g single dose instead of using doxycycline, which is contraindicated in pregnant or nursing mothers. Alternative treatments include: erythromycin base 500 mg PO qid for 7 days, erythromycin ethylsuccinate 800 mg PO qid for 7 days, ofloxacin 300 mg PO bid for 7 days, or levofloxacin 500 mg PO qd for 7 days. If Trichomonas is the etiologic agent, treat with metronidazole 2-g single dose. For herpes, treat with acyclovir 200 mg PO five times daily for 7 days.
Cervicitis responds well to antibiotics. Possible complications to watch for are a subsequent PID and infertility (found in 5% to 10% of patients). Repeat cultures should be performed after treatment. Sexual relations can be resumed after negative cultures.
If subsequent PID develops, consider hospital admission for IV antibiotics.
PEARLS & CONSIDERATIONS
Patient educational material can be obtained from local health clinics and clinics for sexually transmitted diseases.
Cervicitis is usually asymptomatic or associated with mild symptoms. Copious purulent or mucopurulent in vaginal discharge (Fig. 86), pelvic pain, and dyspareunia may be present if cervicitis is severe. The cervix can be erythematous and tender on palpation during bimanual examination. The cervix may also bleed easily when obtaining cultures or a Pap smear. May have postcoital bleeding.
• Neisseria gonorrhoeae
• Herpes simplex
• Trichomonas vaginalis
• Human papillomavirus