Cervicitis: Causes, Symptoms, Treatment and Care in India

• Cervicitis is inflammation of the cervix — a clinical finding, not a single disease. It can be infectious or non-infectious, acute or chronic.
• Sexually transmitted infections, especially chlamydia and gonorrhoea, are the most common cause in sexually active women.
• Up to 70% of women with chlamydial cervicitis have no symptoms, which is why screening — not waiting for symptoms — catches most cases.
• Untreated infectious cervicitis can ascend to cause pelvic inflammatory disease (PID), tubal infertility and ectopic pregnancy.
• Treatment is pathogen-directed; partners must be tested and treated too, or reinfection is the rule, not the exception.
• Free, confidential testing and treatment are available at NACO-designated STI clinics across India.

Cervicitis is a clinical description, not a single disease. When a clinician says you have cervicitis, they mean your cervix shows one or more signs of inflammation on examination: mucopurulent (yellow or grey-green) discharge from the cervical opening, sustained bleeding when a swab brushes the surface (called cervical friability), or visible redness and swelling of the cervical lining. The American College of Obstetricians and Gynecologists (ACOG) defines it as mucopurulent endocervical discharge or sustained endocervical friability.

It helps to know what cervicitis is not. It is distinct from cervical ectropion — a normal, hormone-driven turning-out of glandular cells onto the surface of the cervix that often looks red but is not inflamed and rarely needs treatment. It is also different from cervical dysplasia, the HPV-related cell changes picked up on a Pap smear, and from "cervical erosion" in the older nomenclature. Indian gynaecologists often see these terms confused on previous reports; true cervicitis warrants a swab and culture, while ectropion usually does not.

Cervicitis can be acute (sudden, often infectious, usually with discharge) or chronic (low-grade inflammation lasting months, often non-infectious or post-infectious). The cervix sits at a crucial border — between the relatively sterile upper genital tract and the bacteria-rich vagina — and its mucus plug is meant to keep ascending infection out. When cervicitis breaches that defence, infection can climb to the uterus and fallopian tubes. That is why cervicitis is never just cosmetic: even an asymptomatic woman with a friable cervix and a positive chlamydia test needs full treatment.

Sexually transmitted infections account for the majority of acute cervicitis in sexually active women.

Chlamydia trachomatis is the single most common cause. It favours the columnar lining of the cervical canal, often produces no symptoms, and is a leading contributor to tubal-factor infertility seen at Indian referral centres. Read more in our guide to chlamydia symptoms and treatment in India. Neisseria gonorrhoeae produces a more florid, purulent cervicitis and is now frequently antibiotic-resistant — the WHO-recommended dual therapy was adopted by NACO and FOGSI; see gonorrhoea in Indian women.

Trichomonas vaginalis causes the classic 'strawberry cervix' (tiny haemorrhages on the inflamed surface), is detectable on wet mount, and is treated with oral metronidazole or tinidazole — details in our trichomoniasis guide. Mycoplasma genitalium is increasingly recognised as a cause of persistent cervicitis that fails standard therapy. Herpes simplex virus produces painful, ulcerative cervicitis and can shed without symptoms — our genital herpes guide explains suppression. Bacterial vaginosis and candida are non-classical causes that can still inflame the cervix.

NACO's syndromic management at designated STI clinics treats the commonest pathogens empirically even without lab confirmation — a pragmatic, free option for women without lab access.

• Retained foreign bodies — a forgotten tampon, a misplaced menstrual cup, a stuck contraceptive ring
• Latex condoms in women with a latex allergy
• Spermicidal jellies containing nonoxynol-9
• Douching products, which FOGSI and other gynaecology bodies actively discourage
• Intrauterine device strings rubbing the cervix in the first weeks after insertion
• Perfumed feminine washes, scented panty liners and bath products
• Allergic reaction to semen proteins (uncommon, but real and reproducible on testing)

• Abnormal discharge — yellow, grey, green or purulent, heavier than usual
• Bleeding after sex (post-coital bleeding) or pink-tinged discharge — a strong clue to a friable cervix
• Spotting between periods unrelated to ovulation
• Pain with deep penetration (dyspareunia) or a low pelvic ache
• Urinary frequency or burning that mimics a UTI but with a negative urine culture
• A heavy, unfamiliar odour

Diagnosis begins with your history — a new partner, condom use, your last STI test, whether you have an IUD, recent procedures, douching and hormonal status — and proceeds to a speculum examination, the single most important step. A clean, dry speculum exposes the cervix; the clinician inspects for mucopurulent discharge, friability (touch the opening with a swab and watch for bleeding), redness, ulcers, ectropion, polyps and visible IUD strings.

From there, swabs are taken depending on availability and budget: a NAAT for chlamydia and gonorrhoea (the gold standard — roughly ₹800–2,500 in private Indian labs, free at NACO-designated STI clinics; see STI testing in India: cost and anonymity); a wet mount for trichomonas, yeast and the clue cells of bacterial vaginosis; an HSV test if ulcers are visible; and a Pap smear or HPV co-test if not done recently. The clinician also checks for cervical motion tenderness — pain when the cervix is moved — which raises concern for ascending PID. A pelvic ultrasound is added if PID is suspected. Women without insurance can access free syndromic management at NACO clinics, where treatment is given on symptoms and exam alone, without waiting for lab results.

• Chlamydia — doxycycline 100 mg twice daily for 7 days is now preferred first-line (azithromycin in pregnancy)
• Gonorrhoea — a single intramuscular dose of ceftriaxone, often combined with doxycycline until chlamydia is excluded
• Trichomoniasis — metronidazole, as a single dose or a 7-day course
• Mycoplasma genitalium — sequential therapy guided by resistance testing where available
• Herpes simplex — valacyclovir or acyclovir for a first episode, with suppression for frequent recurrences
• Bacterial vaginosis — oral or vaginal metronidazole or clindamycin

Gynaecology bodies treat even symptomless cervicitis seriously because of the path untreated infection takes. The cervix is the gate; the upper genital tract is the territory beyond. When chlamydia or gonorrhoea ascends — usually silently — it produces inflammation of the uterine lining, then of the fallopian tubes (salpingitis), then potentially a tubo-ovarian abscess and adhesions. This is pelvic inflammatory disease.

The end-stage findings are chronic pelvic pain, tubal-factor infertility, and the surgical emergency of ectopic pregnancy. Damaged or blocked tubes are a common reason that women struggle to conceive. The same trajectory is what makes routine annual chlamydia and gonorrhoea screening one of the most cost-effective interventions in reproductive medicine. The practical message for Indian women is twofold: take any abnormal discharge or post-coital bleeding seriously enough to seek a swab rather than self-treat with over-the-counter antifungals, and make sure any positive STI test leads to your partner being treated too, even if he has no symptoms.

Cervicitis in pregnancy carries higher stakes. Chlamydia and gonorrhoea in pregnancy raise the risk of preterm rupture of membranes, preterm birth, low birth weight and postpartum infection of the womb. They can also pass to the baby during delivery, causing neonatal eye infection and, with chlamydia, neonatal pneumonia — which is why many Indian antenatal protocols include a first-trimester swab for higher-risk women. Treatment uses pregnancy-safe regimens (for example, azithromycin for chlamydia rather than doxycycline, which is avoided in pregnancy); see chlamydia during pregnancy.

At the other end of life, post-menopausal cervicitis is overwhelmingly atrophic rather than infectious. Low oestrogen thins the cervical and vaginal lining, producing a fragile, easily bleeding surface that mimics infection. Vaginal oestrogen cream or pessary, used a few nights a week for around six weeks, usually settles it — our guide to atrophic vaginitis after menopause covers this. Importantly, a persistently friable cervix despite adequate oestrogen, or any bleeding after menopause, must be investigated with a Pap smear, HPV test and — where indicated — colposcopy to rule out malignancy.

• Use condoms consistently and correctly — the single most effective behavioural step short of monogamy with a tested partner
• Get STI screening annually if you're under 25 and sexually active, or have a new or multiple partners — free at NACO clinics
• Treat partners every time — reinfection from an untreated partner is the dominant cause of recurrent cervicitis
• Avoid douching, perfumed washes, scented panty liners and vaginal deodorants — they disturb protective vaginal flora
• Choose latex-free condoms (polyurethane or polyisoprene) if you suspect a latex allergy
• Keep IUD follow-up appointments so any string-related irritation or infection is caught early
• Consider HPV vaccination — it doesn't prevent cervicitis itself but reduces HPV-related cervical disease; FOGSI recommends it through age 45 (and routine cervical cancer screening still matters)

A woman seeking evaluation for suspected cervicitis in India has three reasonable routes.

The free public route is a NACO-designated STI clinic, available in district hospitals and many tertiary centres. Syndromic management, partner-notification cards and follow-up are all free, and staff are trained in confidentiality.

The mixed-cost route is a government medical college or municipal hospital OPD, where the consultation is roughly ₹50–200, basic swabs are subsidised and Pap smears are free or nearly free — though waiting times are long.

The private route is a gynaecologist OPD (around ₹600–2,500), a private lab for NAAT (₹800–2,500) and a same-week appointment cycle. AIIMS, JIPMER, PGIMER and CMC Vellore run gold-standard public referral chains for complex cases — recurrent cervicitis, drug-resistant gonorrhoea, suspicious cervical lesions and pregnancy-related STIs. For sexually active urban women, an annual gynaecology check that bundles a speculum exam, an NAAT swab if indicated, a Pap or HPV co-test (by age) and a contraception chat is a sound investment relative to the lifetime cost of tubal infertility.

• Abnormal vaginal discharge — especially yellow, green, grey or foul-smelling
• Bleeding after sex, or spotting between periods that isn't your usual pattern
• Pelvic or lower abdominal pain, fever or pain with deep sex — these can signal PID and need urgent care
• A positive STI test in you or your partner
• Any bleeding after menopause, which always needs investigation
• Symptoms that persist or recur after a course of treatment — you may need a test-of-cure and partner treatment

• ACOG — Vaginitis and Cervicitis in Nonpregnant Patients
• CDC — Sexually Transmitted Infections Treatment Guidelines: Cervicitis
• WHO — Sexually transmitted infections (STIs) fact sheet)
• NHS — Chlamydia
• National AIDS Control Organisation (NACO), India — STI/RTI Services