[Question #221] Cervicitis

97 months ago
I've wrote 3 times describing my situation. I went to a different obgyn this time and he examined me. He did 2 swab tests for chlamydia and gonorrhea since he said Im suffering from cervicitis.  I have to wait 2 weeks for the results and like its been clear herpes is a big concern for me. Ive been having my symptoms for 6 weeks and 2 days now. Vaginal burning, the entrance of my vagina hurts and pelvic pain. My first obgyn examined me like 3 times before she examined me under general anesthesia looking for any lesion, blisters or something like that. She always stated "you are clean and everything looks clean". Now the new obgyn just swabbed for clam and gono and since he didnt swabbed for herpes Im assuming he didnt saw anything suggesting it. I have 2 Igg blood tests negative for both types (0.2) with a window period of 9 months between them. Last one was made after almost 2 years after  my last possible exposure. My biggest concern is HSV 1 due to oral sex. 
1. Should I still be concerned about herpes causing my symptoms?
2. How often or common do herpes cause cervicitis?
3. Can I have outbreaks in my cervix without blisters or sores? 
4. If my swabs came back negative, what can be causing this? 
5. Should I trust both of my obgyns in the fact that Im assuming they didnt saw any red flag for herpes?
6. How long do herpes in the cervix last? 
I've never had a cold sore in my life and this is the first time this is happening to me. Im using vaginal cream for yeast since Im taking a lot of meds that doesnt seem to help. By the time I have the appointment to discuss my results its gonna be 2 months since my first symptoms. Can it be herpes? Help me! The anxiety has been killing me this past weeks and I have lost weight 
cuz I dont even wanna eat and Im skipping classes since I cant concentrate on anything. I have a new partner now and everything is causing me lots of stress. 
H. Hunter Handsfield, MD
97 months ago
Welcome back to the forum. I'm sorry you continue to be so concerned about your symptoms and the possibility of herpes. In quickly scanning your three previous discussions with Terri, I see no evidence that you are likely to have herpes and, honestly, no symptoms that make me suspicious of it.

Before going to these specific questions, a comment about " having my symptoms for 6 weeks and 2 days now". All by itself, that is strong evidence against HSV as the cause. Herpes outbreaks simply never cause symptoms that long. Every herpes outbreak clears on its own, usually within 10-14 days for a recurrent oubreak and within 3-4 weeks for the first infection. When we consider 1) the nature of your symptoms (no blisters, open sores, etc), 2) their duration, as just discussed, and 3) your negative blood tests more than 2 years after your last possible exposure, there simply is zero chance you have genital herpes. I could envision the rare indvidual with herpes despite any one of these three factors. But the statistical likelihood of all three breaking the wrong way is simply too low to contemplate. The chance you'll be struck by lightning someday is far higher than the chance you have genital herpes.

Now to your specific questions:

1) For the reasons above, you should not be at all concerned about having genital herpes.

2) This is the wrong question, and it doesn't matter. What should be on your mind isn't how often herpes causes cervicitis, but how often a woman with cervicitis has herpes as the explanation. In the absence of other symptoms or signs of herpes, the answer is "extremely rarely". That you may have had cervicitis doesn't change all the facts and probabilities already discussed. Whatever the cause of your possible cervicitis, it isn't HSV.

3) Herpes can cause internal cervical and perhaps vaginal outbreaks. But not in your case.

4) The causes of cervicitis are poorly understood. About half of all cases have no proved cause. Maybe someday research will give answers -- but in the meantime, there is no reason to suspect herpes for most of them, and certainly not for long-standing, ongoing cervicitis (see above about the duration of herpes outbreaks).

5) Yes. I'm sure your ObGs are correct, and implicitly understand the reasons I have given myuself.

6) See above; probably never more than a couple of weeks.

My final advice is to not assume that just because you have a health problem or symptoms whose cause is unknown that it must be something bad, or that it must be the one thing that for some reason most occupies your mind. I would further suggest that you should stop searching for answers, and for sure stop trying antibiotics or other treatments. And get off the anti-yeast treatments. Leave everything alone for a few weeks -- then recheck if symptoms persist. In the meantime, I am 100% certain you don't have genital herpes or any other STD.

I hope this has helped you move toward putting all this to rest. Best wishes--


97 months ago
Hi! Thank you so much for answering my question... I've read a lot about you and its an honor. Since I've read a lot about your advises I saw an old post on Medhelp where there was a young woman with cervicitis too and it wasnt due to chlamydia or gonorrhea so you told her that "cervicitis not due to chlamydia or gonorrhea is a big mystery" and then you said "herpes is possible". My very first symptoms were: itchy vulva, swollen vagina (like I had something causing pressure in it) and vaginal burning. When I felt like something popped or burst inside I felt like a really sharp sore throat but I took Ibuprofen and it went away. After that I had a really bad buttock pain (like in the sciatica) with a lot of sensitivity in my left leg (it lasted a week or so). The fever started after I took the Difulcan and only happened twice. 
Now, Im still feeling unwell and Im tired of this situation. It scares me that Terri told me that the common screening test is not very good with the hsv1 detection, what if it is missing my infection?. Also Ive read that there are people that doesnt develop antibodies ever, what if Im 1 one them?. It also scares me the possibility of having outbreaks inside the cervix and not on the os, would that be possible? Why are you so sure thats not happening to me? After my first obgyn examined me for the last time it was when my "spotting" started and then the other doctor said it was cervicitis after he examined me. Also in the report that my first doctor filled after the examination under anesthesia she reported "large cervix ectropion", could that be related to my symptoms? What can be causing having the entrance of my vagina almost swollen shut and very painful? Its like a burning pain and that has been the persistent symptom since day 1.   
Thank you so much for taking your time to answer my questions! 
H. Hunter Handsfield, MD
97 months ago
Thank you for your kind comments. However, there is nothing in these additional symptoms that changes my opinion or advice. Without examining you, I cannot explain your vaginal irritation and swelling, except that it isn't herpes, which does not cause such symptoms without visible blisters or open sores. Up to 10% of yeast infections are resistant to the azole drugs and need different treatments, so that may be a consideration. Other possibilities include allergy (e.g. to vaginal hygiene products, detergents left over after washing your underclothes), and various chemical irritants. And other possibilities as well. And there are all sorts of potential causes other than herpes of all the other symptoms you have had at one time or another.

It would seem you have read (and perhaps became hung up on) lists of herpes symptoms, and you fear that having any one of them means you might have herpes. It doesn't work that way. Any single symptom rarely is important by itself; what matters is the combination and pattern of symptoms, exam findings, lab tests, and exposure history. For example, herpes lesions may itch or feel irritated, but that doesn't mean that itching or irritation are often explained by herpes; they are not. Your pattern and combination of these factors simply doesn't fit herpes. 

Finally, the large majority of unexplained genital conditions are not herpes or other STDs. On the bookshelf at my left elbow, there is a color atlas of genital dermatology. It is over 300 pages long, with 16 chapters -- and on quick scan I would estimate that only about 10 pages are on herpes or other STDs, i.e. under 5% of the book. Believe it, accept it, and do your best to move on. If you cannot, I hope you will consider professional counseling, which I suggest from compassion, not criticism. It is not normal to find it so difficult to accept such reasoned, science-based reassurance as you have had from Terri, me, and your personal physicians.

You have one more follow-up comment and reply coming on this thread. But please think carefully before asking more "what if" or "yes but" questions. It is unlikely you will think of anything else that would change my opinion or advice.

97 months ago
Hi and thank you for your advice. I know it may seem like Im crazy but its just the fear controlling me. The only symptom I would add is persistent white discharge (since day 1) not like cottage cheese more like white mucus (but you already said thats not gonna change your opinion). I have a doubt... When someone is diagnosed with herpetic cervicitis  does that means that the person is having an outbreak in the cervix or the cervicitis would be a complication due to the virus requiring another treatment?. If someone doesnt have blisters or open sores automatically herpetic cervicitis is ruled out?. Like I mentioned before my previous obgyn reported I have large cervical ectropion. Could that cause cervicitis? Im taking bc pills and I read that cause the erosion. If everything comes back negative and I still keep having cervicitis (i finish my antibiotics tonight), what are my options?. Can this lead to other infections or complications? Can cervical erosion be mistaken with cervicitis and viceversa?. Im 23 and really wanna keep enjoying my sex life but this vaginal burning pain in the entrance of my vagina seems to be eternal and Im extremely frustrated. It even bothers me more than the "cervicitis". Any other advice you would like to add? 

Thank you so much for everything and like I said before its been an honor being able to have this "conversation" with you. Keep doing your great job and helping people around the world! 
H. Hunter Handsfield, MD
97 months ago
OK -- this will be the last comment on this thread. Let's use it to address cervicitis.

You may be onto something with your comment about cervical ectropion/erosion, which indeed can easily be mistaken for cervicitis. The word "erosion" makes it sound abnormal, but really this is physiologic; it's simply the migration of the lining of the inside of the cervix (endocervix) onto the outside of the cervix. It happens to most young women around the time menstruation starts and persists 2-4 years; commonly recurs during pregnancy; and often reappears in women on hormonal contraception. The erosion area can get inflamed, probably from normal vaginal bacteria -- and bingo, apparent cervicitis is present. However, to confuse things, true cervicitis can cause ectropion/erosion, so it can be difficult to sort out. Discuss this with your gynecologist.

If you have not been tested for Mycoplasma genitalium, speak with your doctor about it. M genitalium is the most recently documented bacterial STD pathogen. After a few years of controversy, it is now known for sure to cause urethritis (NGU) in men and cervicitis and PID in women. Commercial tests are only starting to become routinely available, but expert physicians and reliable labs can get access to good tests. M gen can be difficult to treat; the antibiotic azithromycin usually is tried first, or moxifloxacin if that doesn't do it.

However, neither cervicitis, ectropion/erosion, nor M genitalium, on their own, are likely causes of external pain and irritation. As suggested above, talk with your doctor about yeast resistant to the usual treatments. It can be difficult to identify yeast by standard testing, so you might need a culture; or try a non-azole yeast treatment like nystatin, flycytosine, or caspofungin.

Many experts would advise a period of sexual abstinence or consistent condom use for cervicitis that doesn't otherwise clear up or respond to treatment. I would stress that there is no good evidence that sex per se or semen exposure contribute to the problem, but maybe worth considering if all else fails.

An option for further mangement is to ask for referral to a gynecologist who subspecializes in infectious diseases. They usually can be found in major metropolitan areas and/or large medical centers.

Having said all that, the good news is that no serious complications are known to result from cervicitis not due to chlamydia, gonorrhea, or M genitalium. In the worst case scenario, i.e. continued symptoms and possible cervicitis, you are unlikely to have any serious outcomes. You should look at all this as primarily an issue of symptom control, not a sign of an important health risk.

Finally, regarding herpes:  FOR SURE it isn't the problem here. Suck it up, believe it, and stop obsessing about that possibilty. Do not mention that possibility to any sex partner(s) and cease efforts to evaluate that possibility any further. I suggest you re-read all the replies up til now -- above and in the discussions with Terri -- and put it out of your mind.

Thanks again for your thanks and kind words. I hope this discussion has helped. Best regards.