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1. Endocervicitis
a. C. trachomatis
b. N. gonorrhoeae
c. Herpes simplex virus
2. Ectocervicitis
a. Trichomonas vaginalis
b. Herpes simplex virus
B. Multiple organisms
1. Mycoplasmas do not cause cervicitis, but are isolated as
commensal organisms from lower genital tracts (cervix, vagina) of healthy women
C. Fungal -- C. albicans - ectocervicitis
D. Non-microbial causes
1. Autoimmune
2. Malignancy
3. Physical, chemical, and irradiation trauma
II. Diagnostic Approach
A. Careful history and physical examination (includes full pelvic examination)
B. Examination of vaginal pool
1. pH -- non-specific to cause, but sensitive to many abnormalities of vaginal flora and cervix (> 4.5 is abnormal) clamidia
2. Microscopy of normal saline and potassium hydroxide mounts -- presence of PMNs, clue cells, trichomonads, blastospores and pseudohyphae
C. Gram stain of cervical secretions -- PMNs
D. Microbiology laboratory tests
1. Tests for C. trachomatis and N. gonorrhoeae
2. Test for herpes simplex virus if lesions noted
III. Presumptive Treatment
A. In general, for gonorrhea and chlamydia
B. For other specific pathogens if a high index of suspicion
Topic IB: Urethritis
I. Major Sexually Transmitted Pathogens Are Common Causes
A. In males and in females
B. Organisms associated with urethritis
1. N. gonorrhoeae -- about 30 - 50% of all urethritis
2. C. trachomatis -- about 50% of all nongonococcal urethritis
3. Herpes simplex virus
4. Mycoplasmas -- although multiple species, most famous are
a. Ureaplasma urealyticum -- about 30% of all
nongonococcal urethritis
b. Mycoplasma