Chronic cervicitis means long-term inflammation of the cervix, the lower part of the uterus that connects to the vagina. Inflammation most often develops in the transformation zone, the area where glandular cells lining the inside of the cervix are gradually replaced by squamous cells from the outer surface. Chronic cervicitis is very common and may affect up to half of all women at some point during their adult life. In most cases, it is not dangerous, but it can sometimes cause bothersome symptoms or be associated with an infection.
This article will help you understand the findings in your pathology report, what each term means, and why it matters for your care.
What causes chronic cervicitis?
The causes of chronic cervicitis can be either infectious or non-infectious. Infections are the more common cause.
Common infectious causes include:
- Chlamydia — A common sexually transmitted bacterial infection that often causes few or no symptoms.
- Gonorrhea — Another sexually transmitted bacterial infection that frequently affects the cervix.
- Herpes simplex virus — A viral infection that can cause painful ulcers on the cervix and genital area.
- Human papillomavirus (HPV) — A very common virus that can cause cellular changes in the cervix and is also linked to cervical cancer.
- Syphilis — A sexually transmitted bacterial infection that may produce ulcers and other cervical changes.
- Trichomoniasis — A sexually transmitted parasitic infection that often produces a frothy vaginal discharge.
- Bacterial overgrowth — Overgrowth of other bacteria normally found in the vagina can also produce ongoing inflammation in the cervix.
Non-infectious causes are related to irritation, injury, or allergic reaction rather than infection:
- Intrauterine device (IUD) — The presence of an IUD can cause low-grade chronic inflammation of the cervix.
- Pessaries, tampons, or other vaginal products — Long-term contact with these products can irritate the cervix.
- Chemical irritants — Douches, contraceptive creams, or other chemical products can cause ongoing irritation.
- A ruptured cervical cyst — Inflammation from the contents of a ruptured cyst can produce ongoing changes.
- Allergic reaction — Reactions to spermicides, latex condoms, or other products may trigger persistent inflammation.
What are the symptoms?
Many people with chronic cervicitis have no symptoms, and the condition is first noticed only when a Pap test or biopsy shows signs of inflammation. When symptoms do occur, they may include:
- Vaginal discharge — May be increased in amount, change in color, or have an unusual odor.
- Abnormal vaginal bleeding — Bleeding between periods or after intercourse is common.
- Pain during intercourse — Inflammation of the cervix can make sexual activity uncomfortable.
- Pelvic pain or fever — When chronic cervicitis is associated with pelvic inflammatory disease, deeper pelvic pain and fever may also be present.
During a gynecologic examination, the cervix may appear red, irritated, or swollen. When chronic cervicitis is suspected, your doctor may order a Pap test, take swabs from the cervix for laboratory testing, or recommend a biopsy to look for the underlying cause.
How is the diagnosis made?
The diagnosis of chronic cervicitis may first be suspected during a pelvic examination if the cervix looks inflamed. To confirm the diagnosis, a Pap test or cervical biopsy is performed, allowing the tissue to be examined under the microscope by a pathologist. If an infection is suspected, your doctor may also collect swabs from the cervix to send for microbiology testing. The swabs are tested for specific bacteria, viruses, or other organisms, which helps identify the underlying cause and guide treatment.
What does chronic cervicitis look like under the microscope?
When viewed under the microscope, chronic cervicitis shows signs of long-standing inflammation. The pathologist typically sees a combination of the following features:
- Large numbers of immune cells — Especially lymphocytes and plasma cells- are scattered through the tissue that lines the cervix. These are the immune cells typical of chronic (long-standing) inflammation.
- Lymphoid follicles — Round clusters of immune cells beneath the surface epithelium, often present when inflammation has been present for a long time.
- Ulcers or necrosis — Ulcers (areas where the surface lining has been lost) and necrosis (cell death) may be seen, particularly with bacterial infections.
- Multinucleated giant cells — Multinucleated giant cells are very large cells with more than one nucleus. They are characteristic of certain viral infections, including herpes simplex.
- Reactive cellular changes — The squamous and glandular cells lining the cervix may appear slightly altered in response to the inflammation. These changes are reactive and not precancerous, though they can sometimes be reported on a Pap test as “atypical” and prompt further evaluation.
These microscopic features confirm that the inflammation has been present for a long time and help distinguish chronic cervicitis from other causes of cervical change, including precancerous and cancerous conditions.
What happens after this diagnosis?
Treatment of chronic cervicitis depends on the underlying cause. The findings on the pathology report and the results of any microbiology testing guide the discussion between the patient and the doctor about what should happen next.
- If a specific infection is identified — Antibiotics may be considered for bacterial infections, and antiviral medications may be considered for viral infections. The specific drug depends on the organism identified on swab or culture.
- If an irritant or device is the likely cause — The team may discuss removing or replacing an IUD or stopping use of a vaginal product that may be contributing to the irritation.
- If no specific cause is found and there are no symptoms — Active treatment may not be needed. The doctor may recommend a follow-up examination or repeat Pap test after a defined interval to confirm that the inflammation has resolved.
- If pelvic inflammatory disease is suspected — Additional testing and more intensive treatment may be discussed, often involving a referral to a gynecologist.
Most people with chronic cervicitis recover fully once the underlying cause is addressed. In some cases, follow-up cervical screening is recommended to make sure the inflammation does not mask another condition such as a precancerous change.
Questions to ask your doctor
- Was an infection identified as the cause of my cervicitis, and if so, which one?
- Do I need antibiotics, antiviral medication, or another type of treatment?
- Could my IUD, tampons, or another vaginal product be contributing to the inflammation?
- Should my sexual partner also be tested or treated?
- What symptoms should I watch for that may suggest pelvic inflammatory disease or another complication?
- Were any cellular changes on my Pap test that need additional evaluation?
- Will I need a follow-up Pap test or biopsy after treatment, and when?
- Should I have HPV testing or other tests to rule out a precancerous condition?
- Are there any lifestyle changes that might help reduce the inflammation?
- How long will it take for the inflammation to fully resolve?
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