cervicitis is defined clinically by the presence of either mucopurulent discharge or easily induced bleeding at the endocervical os , more subtle signs include edema of the cervical ectropion ( edematous ectopy ) and the presence of an elevated number of polymorphonuclear leukocytes , as detected by gram staining of a smear of endocervical secretions under high - power magnification1 . other organisms include : herpes simplex virus ( hsv ) , human papillomavirus ( hpv ) and trichomonas vaginalis . hsv serological testing should be considered for people presenting for a sexually transmitted disease evaluation , especially for those people with multiple sexual partners and people with hiv infection . herpes cervicitis becomes important when observed in a woman of reproductive age group because of the risk of neonatal infections resulting from exposure to hsv in the genital tract during delivery . hsv is shed asymptomatically from multiple anatomical sites and shedding , like exposure , is a significant risk for transmission . non - neoplastic diseases are predominantly inflammatory however there are few publications on the subject compared to neoplastic diseases of the cervix . common causes include chemical irritations secondary to douching or local trauma produced by pessaries and intrauterine contraceptive devices . a 28-year old female trader referred to the special treatment clinic ( stc ) of the university college hospital ( uch ) ibadan , nigeria with cervical cytology suggestive of herpes simplex cervicitis . this was detected on routine screening for cervical cancer using pap smear which showed superficial , intermediate , parabasal and endocervical cells . also seen are binucleated epithelial cells , all of which were suggestive of herpes simplex cervicitis ( figure 1 ) . she is para 3 + 0 , 3 alive ; last child birth was 4 years ago . all her pregnancies were uneventful and delivered per vaginum with no history of delivery of congenitally malformed baby . though with a desire for future pregnancy , she currently has an intra - uterine contraceptive device ( iucd ) ( copper t 380a ) which was placed 2 years ago . her last menstrual period was on 20th may 2012 ( 5 days prior to presentation ) . she denied a positive history of multiple sexual partner , however she confirmed that her spouse has other sexual partners ( number not revealed ) . she had no complaints referring to presence of a sexually transmitted infection at presentation but affirmed to a history of previous recurrent whitish vaginal discharge with no genital malodor . no dysuria or hematuria . physical examination revealed a healthy looking young lady with major findings in the genital system . the external genitalia appeared normal with no blisters , ulcers , warts or other genital / perianal lesions . speculum examination of the vagina exposed scanty , whitish mucopurulent discharge with no peculiar odor emanating from the cervical os . the ectocervix appeared reddened , edematous , mildly tender on gentle swabbing ( no bleeding ) with the iucd string protruding from the endocervix ( figure 2 ) . elisa for herpes simplex virus 1 and 2 igm screening ( diapro diagnostics , milan , italy ) was positive . chlamydia and syphillis screening were also negative . the endocervical swab taken yielded normal flora . she was re - assessed at the follow up clinic and examination of the cervix showed a marked improvement in the cervical inflammation earlier observed ( figure 3 ) . infections of the cervix represent an important reservoir for the sexual or perinatal transmission of pathogenic microorganisms and the usual source from which upper genital tract infections develop . genital herpes simplex virus infection is common and involves , in the order of frequency , the cervix , vagina , and vulva . the frequency of genital herpes has increased dramatically in the past decades , particularly in teenagers and young women . by the age of 40 , about 20% of women are seropositive for antibodies against hsv-2 . hsv cervicitis occurs in 70 - 90% of primary hsv-2 infections and about 70% of primary hsv-1 infections . however there are no conclusive data on seroprevalence of herpes simplex cervicitis in most parts of the world , this is partly because the prevalence of this disease is very difficult to ascertain by case reporting , as most of the cases are clinically in apparent . some of the identified risk factors for herpes cervicitis were found to be present in our index case . she had an intra uterine device in situ for over two years , positive history of an apparently asymptomatic spouse with multiple sexual partners and early age at onset of sexual intercourse . however , in the index case , speculum examination of her cervix revealed a hyperemic and friable cervix , with copious creamy white discharge from the endocervical canal , while ulcers / erosions were absent . this is more in keeping with cervicitis caused by trichomonas vaginalis , chlamydia trachomatis or neisseria gonorrhoea which are more common causes of infectious cervicitis and as such are usually considered first as differentials . hence many patients go undiagnosed and untreated for herpes cervicitis . however , culture of the endocervical discharge in this patient yielded normal flora , she was also negative for chlamydia , trichomonas vaginalis and gonorrhoea . the diagnosis of hsv-2 in our patient was done using enzyme - linked immunoabsorbent assay . the sensitivity of these tests for detection of hsv-2 antibody vary from 80% to 98% , while the specificity of these assay is above 96% . we did not have facilities for cell culture which is gold standard for diagnosis of herpes simplex virus infection with a higher specificity of above 99% . we also do not have facility for polymerase chain reaction , which is highly sensitive , even more than viral culture , and highly specific as well . to the best of our knowledge , this is the first case of herpes cervicitis to be reported from this centre . had earlier reported herpes simplex infection among attendees of our special treatment clinic .it has been documented that prompt initiation of anti herpetic treatment shortens the duration of the disease , and may reduce rate of recurrence and virus shedding by inhibiting replication . genital hsv infection has been associated with persistent inflammatory cervical smears in a study done ; the increased cervical cancer risk was associated with a history of chronic cervicitis . in another study focusing on gynecological infections other than hpv as risk determinants of subsequent cervical neoplasia , association with cervical hsv infection gave the highest and statistically most significant increase in risk . studies have shown that prevalent hsv-2 infection is associated with a 2 - 3 fold increased risk of acquiring hiv infection , while incident hsv-2 infection is associated with an even higher risk of acquiring hiv infection . genital hsv-2 infection is thought to facilitate transmission of hiv infection from persons who are coinfected with both viruses . without typical clinical symptoms of hsv infection , the patient is generally not screened for hsv infection thus putting the women at risk . this case was a young woman in the reproductive age group who desired to have more children . this incidental finding and treatment of this index case has probably contributed to preventing the complications of genital hsv infection viz a viz the possibility of sexual transmission of the disease , as well as perinatal transmission with emergence of congenital malformation in infants of infected mothers . this case also illustrates the importance of effective routine pap smear for sexually active women . in conclusion , cervicitis increases the risk of poor pregnancy outcome , predicts upper genital tract disease , and is associated with increased shedding of hiv-1 from the cervix in the absence of chlamydial and gonococcal infection . hence determining the etiology of this condition therefore it should be considered as a differential diagnosis of cervicitis among sexually active women particularly those with intrauterine device .