Endocervicitis is inflammation of the inner lining of the cervix, specifically the canal that connects the uterus to the vagina. It affects the delicate, column-shaped cells that line this canal, and it’s most often caused by a sexually transmitted infection. Many people with endocervicitis have no symptoms at all, which is part of what makes it potentially dangerous: left untreated, the inflammation can spread deeper into the reproductive tract.
What Happens Inside the Cervix
The cervical canal is lined with a single layer of tall, column-shaped cells (columnar epithelium). When these cells become inflamed, blood vessels in the tissue swell and enlarge, and immune cells flood into the area. In mild cases, some of the surface cells are stripped away. In more severe cases, the tissue can develop open sores, or ulceration, across the surface. The deeper cell layers become swollen and packed with white blood cells as the body mounts an immune response.
Visually, inflamed columnar tissue appears intensely red and bleeds easily when touched. An opaque, pus-like discharge often covers the opening of the cervix. This is distinct from cervical ectropion, a harmless condition where normal columnar cells simply extend onto the outer surface of the cervix. Ectropion looks red and smooth, resembling granulation tissue, but it doesn’t produce the thick discharge, swelling, or easy bleeding that characterize true endocervicitis.
Common Causes
Infections are by far the most frequent trigger. In 30% to 50% of infectious cases, the cause is either chlamydia or gonorrhea. Chlamydia is the more common culprit, responsible for four to five times as many cases as gonorrhea. Other infections that can cause endocervicitis include herpes simplex virus, trichomoniasis (which can produce a distinctive “strawberry” appearance of tiny red spots across the cervix), human papillomavirus, syphilis, and a bacterium called Mycoplasma genitalium.
Non-infectious causes exist too, though they’re less common. Chemical irritation from spermicides, douches, or latex in condoms or diaphragms can trigger inflammation in some people. Hormonal changes and allergic reactions to products used in or around the vagina are also recognized triggers. In a significant number of cases, no specific cause is ever identified.
Symptoms to Watch For
Endocervicitis is frequently silent. When symptoms do appear, the most recognizable is an unusual vaginal discharge that may be yellow-green and pus-like. Other common signs include bleeding between periods, bleeding after sex, and pain during intercourse. Some people experience a dull ache or pressure in the pelvis.
The tricky part is that these symptoms overlap with many other gynecological conditions, from vaginal infections to cervical polyps. Discharge alone isn’t enough to confirm endocervicitis, which is why a clinical exam matters.
How It’s Diagnosed
During a pelvic exam, a clinician looks for the hallmark signs: a thick, yellowish discharge visible on a white swab (sometimes called the “swab test”), redness, swelling of the cervix, and tissue that bleeds when gently touched. A sample of cervical secretions is then examined under a microscope. The key finding is an elevated number of white blood cells: 10 or more per microscopic field is the standard threshold that points toward active inflammation and correlates with the presence of infections like chlamydia.
Testing for specific infections typically follows, using swabs sent for lab analysis. This step is important because treatment depends on which organism is causing the problem.
Treatment and What to Expect
When a bacterial infection is the cause, antibiotics clear most cases effectively. The standard approach is a seven-day course of an antibiotic taken twice daily. For people who can’t complete a week-long regimen, a single-dose alternative is available. If gonorrhea is suspected or the person lives in an area where gonorrhea is common, an additional antibiotic targeting that specific bacterium is added.
Sexual partners typically need treatment as well, even if they have no symptoms, to prevent reinfection. Most people are advised to avoid intercourse until both they and their partner have finished treatment. Symptoms usually improve within a week or two, though a follow-up visit may be recommended to confirm the infection has cleared.
For non-infectious cases, treatment focuses on removing the irritant. Switching to a different type of contraceptive, stopping douching, or avoiding the offending product is often all that’s needed. If inflammation persists without a clear cause, a clinician may use a targeted procedure to remove or treat the affected tissue.
Why Treatment Matters
The most serious risk of untreated endocervicitis is that the infection climbs higher into the reproductive tract, causing pelvic inflammatory disease (PID). PID can lead to scarring in the uterus, fallopian tubes, or ovaries. That scarring, in turn, raises the risk of chronic pelvic pain, difficulty getting pregnant, and ectopic pregnancy, where a fertilized egg implants outside the uterus.
There’s another, less obvious risk. An inflamed cervix is a weaker barrier. The damaged, swollen tissue lets viruses and bacteria pass into the body and bloodstream more easily, which increases susceptibility to other sexually transmitted infections, including HIV. This is one of the strongest reasons to treat endocervicitis even when symptoms seem mild or manageable.