Clinical and Microbiological Profile of Recurrent and/or Persistent Cervicitis in Patients Attending Suraksha Clinic

Cervicitis is an inflammation of lower genital tract characterized by endocervical discharge and or bleeding and or >10 pus cells per high power field on microscopy. Its significance is its association with pelvic inflammatory disease. Various implicated organisms for cervicitis include Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Herpes simplex virus, Mycoplasma genitalium, and Ureaplasma species. Approximately 33% of cervicitis cases are recurrent and 18% may show persistence. Persistent or recurrent cervicitis despite antimicrobial therapy requires detailed evaluation. There is limited literature on the clinical and microbiological profile of such cases.

To determine the clinical and microbiological profile of recurrent and/or persistent cervicitis in patients attending Suraksha clinic at a tertiary care centre.

A cross-sectional study was conducted among 40 women aged 18-45 years with recurrent and/or persistent cervicitis, despite treatment. Detailed evaluation was done including history, examination, and investigations which did not give any clues regarding the etiology. Multiplex-PCR for various pathogens was done. Statistical analysis was performed using SPSS version 25.

Mean age of cases was 31.77 ± 6.99. Duration varied from <1 year to >5 years. All patients had >2 cervicitis episodes, with 15% reported persistent symptoms. High-risk behaviour was noted in 62.5%, with first sexual contact before 18 years in 42.5%, premarital contact in 10%, and history of other STIs in 25%. High-risk behaviour in partners was reported by 85%. Clinical presentation included cervicovaginal discharge (most common), dysuria, lower abdominal pain, and dyspareunia. Multiplex-PCR detected pathogens in 70% of cases (gardnerella: 47.5%, ureaplasma: 40%, trichomonas: 5%, chlamydia: 2.5%, mixed infections: 22.5%). Higher pus cell counts correlated significantly with detection of one or more organism.

This study highlights the complexity of etiology of recurrent/persistent cervicitis identifying gardnerella and ureaplasma as predominant associated organisms. Multiplex-PCR is a valuable tool to provide insights into such difficult-to-treat cervicitis cases. Large studies with controls are required to verify findings of our study.