title: Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics.
abstract: OBJECTIVE
  Studies examining cervicitis aetiology and prevalence lack comparability due to varying criteria for cervicitis. We aimed to outline cervicitis associations and suggest a best case definition.
  
  
  METHODS
  A cross-sectional study of 558 women at three sexually transmitted infection clinics in Sydney, Australia, 2006-2010, examined pathogen and behavioural associations of cervicitis using three cervicitis definitions: 'microscopy' (>30 pmnl/hpf (polymorphonuclear leucocytes per high-powered field on cervical Gram stain)), 'cervical discharge' (yellow and/or mucopurulent cervical discharge) or 'micro+cervical discharge' (combined 'microscopy' and 'cervical discharge').
  
  
  RESULTS
  Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV) and Neisseria gonorrhoeae (NG) had the strongest associations with cervicitis definitions 'micro+cervical discharge': CT adjusted prevalence ratio (APR)=2.13 (95% CI 1.38 to 3.30) p=0.0006, MG APR=2.21 (1.33 to 3.69) p=0.002, TV APR=2.37 (1.44 to 3.90) p=0.0007 NG PR=4.42 (3.79 to 5.15) p<0.0001 and 'cervical discharge': CT APR=1.90 (1.25 to 2.89) p=0.003, MG APR=1.93 (1.17 to 3.19) p=0.011, TV APR=2.02 (1.24 to 3.31) p=0.005 NG PR=3.88 (3.36 to 4.48) p<0.0001. Condom use for vaginal sex 'always/sometimes' reduced cervicitis risk: ('micro+cervical discharge') APR=0.69 (0.51 to 0.93) p=0.016. Combined population attributable risk % (PAR%) of these four pathogens was only 18.0% with a protective PAR% of condoms of 25.7%. Exposures not associated with cervicitis included bacterial vaginosis, Mycoplasma hominis, Ureaplasma urealyticum, herpes simplex virus 1&2, cytomegalovirus, Candida, age, smoking and hormonal contraception.
  
  
  CONCLUSIONS
  Cervicitis was associated with CT, MG, TV and NG with combined PAR% of these pathogens only 18% in this setting, suggesting other factors are involved. Condoms significantly reduced cervicitis risk. Cervicitis definitions with best clinical utility and pathogen prediction were 'cervical discharge' and 'micro+cervical discharge'.
authors.affiliation: Department of Infectious Diseases, Immunology and Sexual Health, Short Street Centre, St George Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: M Josephine
authors.initials: MJ
authors.lastname: Lusk
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Frances L
authors.initials: FL
authors.lastname: Garden
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia SEALS Microbiology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: William D
authors.initials: WD
authors.lastname: Rawlinson
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia SEALS Microbiology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Zin W
authors.initials: ZW
authors.lastname: Naing
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: Department of Infectious Diseases, Immunology and Sexual Health, Short Street Centre, St George Hospital, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Pam
authors.initials: P
authors.lastname: Konecny
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002584:Cervix Uteri / Q000473:pathology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D005840:Gentian Violet; D006801:Humans; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D015999:Multivariate Analysis; D009517:New South Wales / Q000453:epidemiology; D010619:Phenazines; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000209:etiology*; D002575:Uterine Cervicitis / Q000453:epidemiology / Q000209:etiology*; D019522:Vaginal Discharge; D055815:Young Adult
chemical_list: C035863:Gram's stain; D010619:Phenazines; D005840:Gentian Violet
keywords: CERVICITIS; CONDOMS; DIAGNOSIS; EPIDEMIOLOGY (CLINICAL); M GENITALIUM