A 19-year-old woman returns to your clinic to discuss her recent laboratory tests.

Chlamydia trachomatis is the most common cause of cervicitis in young sexually active women and frequently presents with dysuria, dyspareunia, intermenstrual bleeding, and a normal vulvovaginal exam. It may be asymptomatic or have subtle signs and often affects the endocervix.

Toronto Notes 2023 – Gynecology, “Sexually Transmitted Infections” Section:

“Chlamydia is the most common bacterial STI. Symptoms may include intermenstrual bleeding, postcoital bleeding, dyspareunia, mucopurulent cervical discharge, and dysuria. The vulva and vagina may appear normal.”

MCCQE1 Objectives (Obstetrics and Gynecology > 82-1: Abnormal Uterine Bleeding):

“Candidates should evaluate STI-related cervicitis as a common cause of postcoital and intermenstrual bleeding in young women.”

Other options:

A. Actinomyces israelii is associated with IUD use, not relevant here.

B. Herpes simplex virus usually presents with painful ulcerations, not abnormal bleeding.

C. Treponema pallidum (syphilis) causes painless ulcers or systemic symptoms in later stages.

D. HPV causes warts or asymptomatic cervical dysplasia, not acute symptoms.

====================================================