1 Star2 Stars3 Stars4 Stars5 Stars (No Ratings Yet)

Cervicitis, Ectropion & True Erosion

Description of Medical Condition

Cervicitis, Ectropion & True Erosion
  • Cervicitis — inflammatory changes due to infections
  • Ectropion — eversion of the cervix in pregnancy
  • True erosion — loss of overlying vaginal epithelium due to trauma, e.g., forceful insertion of vaginal speculum in patient with atrophic mucosa

System(s) affected: Reproductive

Genetics: N/A

Incidence/Prevalence in USA:

  • Cervicitis — very common in sexually active women
  • Ectropion — with oral contraceptive use; very common in pregnant women
  • True erosion — occasionally seen in postmenopausal women

Predominant age: Sexually active women

Predominant sex: Female only

Medical Symptoms and Signs of Disease

  • Cervicitis — metrorrhagia, post-coital bleeding, vaginal discharge
  • Ectropion — red cervix due to color of the columnar epithelium
  • True erosion — vaginal bleeding, sharply defined ulcers of cervix

What Causes Disease?

  • Cervicitis — Chlamydia trachomatis, Trichomonas vaginalis
  • Ectropion — hormonal changes with oral contraceptive use (especially with progesterone) or during pregnancy
  • True erosion — injury to atrophic epithelium due to estrogen deficiency in menopause

Risk Factors

    • Cervicitis — sexual contact with infected partner(s). recurrence due to inadequate therapy
Cervicitis, Ectropion & True Erosion
  • Ectropion — pregnancy
  • True erosion — estrogen deficiency, trauma

Diagnosis of Disease

Differential Diagnosis

  • Cervical dysplasia
  • Carcinoma of the cervix


  • Saline and potassium hydroxide preparation of cervical/vaginal smears
  • Chlamydiazyme or chlamydia cell culture, gonorrhea culture
  • Papanicolaou (Pap) smear of the cervix
  • Chlamydia DNA probe
  • Gonorrhea DNA probe

Drugs that may alter lab results: N/A

Disorders that may alter lab results: N/A

Pathological Findings

  • Cervicitis — acute and chronic inflammatory changes, presence of infective organisms
  • Ectropion — none/squamous metaplasia
  • True erosion — sharply defined ulcer borders, loss of epithelium

Special Tests




Diagnostic Procedures


Treatment (Medical Therapy)

Appropriate Health Care


General Measures



No restrictions


No special diet

Patient Education

Provide printed material about sexually transmitted diseases and about estrogen deficiency and estrogen replacement therapy

Medications (Drugs, Medicines)

Drug(s) of Choice

  • Trichomoniasis — metronidazole 500 mg bid for 7 days or 2 g once or 1 g bid for 2 doses
  • Chlamydial infection — for non-pregnant women, doxycycline 100 mg bid po for 7 days; for pregnant women, erythromycin base 500 mg qid po for 7 days, or erythromycin ethylsuccinate 800 mg qid for 7 days
  • Ectropion — none
  • True erosion — estrogen, conjugated vaginal cream daily for 2 weeks, followed by estrogen replacement therapy


  • Metronidazole — first trimester of pregnancy
  • Doxycycline — pregnancy or lactation
  • Estrogen — see extended list of contraindications to estrogen use in standard texts


  • Metronidazole — possible fetal harm if used in first trimester of pregnancy, disulfiram reaction with alcohol
  • Doxycycline — possible fetal harm if used during pregnancy, staining of the infant’s teeth if used during breast-feeding, allergy, photosensitization
  • Erythromycin — nausea or vomiting
  • Estrogens — history of estrogen dependent neoplasms, history of thromboembolic diseases, see extended list of contraindications to estrogen therapy in standard texts

Significant possible interactions:

  • Metronidazole and alcohol
  • Doxycycline and dairy products, iron preparations, warfarin, and oral contraceptives (use backup contraceptive method)
  • Erythromycin with astemizole — may increase latter’s levels with subsequent ECG changes
  • Erythromycin and theophylline (elevated theophylline level)
  • Estrogen — N/A

Alternative Drugs

  • Metronidazole — sulfanilamide-aminacrine-allantoin cream (AVC cream)
  • Doxycycline — erythromycin or azithromycin
  • Erythromycin — clindamycin
  • Estrogen — lubricant, same as that used for vaginal speculum
  • Azithromycin 1 g for one dose only (pregnancy category B)
  • Ofloxacin 300 mg bid x 7 days
  • Amoxicillin-clavulanate (Augmentin) 250 mg po q8h for 7 days

Patient Monitoring

  • Trichomoniasis — repeat vaginal smear until infection is cleared
  • Chlamydial infection — repeat chlamydial culture post antibiotic therapy
  • Estrogen deficiency — re-examine in one month to confirm healing

Prevention / Avoidance

  • Trichomoniasis or chlamydial infection — treatment of sexual partners and use of condom during coitus
  • Estrogen deficiency — estrogen replacement therapy

Possible Complications


Expected Course / Prognosis

  • Cervicitis — excellent healing once infection is eradicated
  • Ectropion — spontaneous regression postpartum, cessation or oral contraceptive use
  • True erosion — spontaneous healing


Associated Conditions

  • Gonorrhea
  • Bacterial vaginosis

Age-Related Factors

Pediatric: N/A

Geriatric: Menopause


  • Ectropion
  • Azithromycin should be used with caution
  • Doxycycline should not be used in pregnancy

International Classification of Diseases

616.0 Cervicitis and endocervicitis

Notify of
Inline Feedbacks
View all comments