STI/RTI basics
Chapter 3. Detecting STI/RTI

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Cervical infections

Cervical infections are much less common than vaginal infections, especially among women who use reproductive health services, and are usually asymptomatic. The cervix is the most common site of infection for gonorrhoea and chlamydia. Even if a woman is asymptomatic, it may be possible to detect signs of infection on careful speculum examination (Table 3.3). Speculum examination may also reveal signs of other infections, including cervical ulcers and warts.

 

Indications and opportunities for screening

Screening may be done:

• any time a speculum examination is performed for other reasons;
• during pregnancy.

People with frequent exposure to STI, such as sex workers, should be screened regularly.

 

Available screening tools

• Careful speculum examination may detect many (but not all) cervical infections (Table 3.3).
• Culture for gonorrhoea is accurate and not expensive or technically difficult to set up in established laboratories (Table 3.2).
• Laboratory tests for chlamydial infection are expensive and miss many infections (Table 3.2). Polymerase chain reaction (PCR) is very accurate but very expensive.

 

Recommended approach

• A careful speculum examination should be done to look for signs of cervical infection (Table 3.3). Speculum examination skills are reviewed in Annex 1. Some asymptomatic internal ulcers and genital warts may also be detected on speculum examination.
• A swab should be collected from the cervical canal (endocervix). If the swab appears yellow when held up against white paper (positive swab test), cervical infection is likely and the woman should receive treatment for gonorrhoea and chlamydia.

• Depending on laboratory resources, endocervical swab specimens can also be:

- cultured for gonorrhoea (Table 3.2);

- tested for chlamydial infection (Table 3.2).

Table 3.3. Clinical criteria for cervical infection

Screening method	Signs	Management
Speculum examination detects some cases of cervical infection.	Mucopurulent discharge (non-clear, yellowish discharge from endocervix).	When any of these signs are present, patient should be treated for both gonorrhoea and chlamydia. Note: at least half the women with cervicitis do not have these signs, and some women with these signs do not have gonorrhoea or chlamydia.
	Friability (easy bleeding) when the cervix is touched with a swab.
	Positive swab test (yellow discoloration of swab inserted in endocervix).

 

Screening is one of the few ways to detect cervical infection and it should not be limited to women with vaginal discharge. Cervical infection is usually asymptomatic and women without vaginal discharge are as likely to have gonorrhoea or chlamydial infection as women with discharge. Despite lack of symptoms, consequences can be severe if infection reaches the upper genital tract.