What Does It Mean to Have a Strawberry Cervix, and How Is It Treated?

Medically reviewed by Elaine K. Luo, MD on January 10, 2018Written by Ann Pietrangelo on January 10, 2018

What is “strawberry cervix?”

The cervix is the lower portion of your uterus that slightly protrudes into the vagina.

If the surface of the cervix becomes irritated and blanketed with small red dots, it’s known as strawberry cervix.

The red dots are actually tiny capillary hemorrhages (punctate hemorrhages). When this occurs on the cervix, the medical term is “colpitis macularis.”

Strawberry cervix isn’t something you can see for yourself. In fact, your doctor may not even be able to identify it during a routine pelvic examination.

But it can be viewed with the aid of a special lighted magnifying instrument called a colposcope. Your doctor may perform colposcopy if you report symptoms such as unusual vaginal discharge.

Keep reading to learn what causes strawberry cervix, other symptoms to look for, and what can be done to treat or prevent it.

What other symptoms are associated with strawberry cervix?

Some women develop strawberry cervix without experiencing other symptoms.

When symptoms do occur, they may include:

  • yellow, gray, or greenish vaginal discharge
  • creamy or bubbly discharge
  • foul-smelling or “fishy” discharge
  • vaginal itching or burning
  • bleeding during or after intercourse or between periods
  • pain during intercourse
  • sensitive cervix (friable cervix)
  • inflammation of the cervix (cervicitis)
  • inflammation of the vagina (vaginitis)
  • redness of the vulva
  • frequent or painful urination
  • lower abdominal pain

These symptoms could be due to a number of different conditions, so it’s important to see your doctor for accurate diagnosis.

What causes strawberry cervix?

Strawberry cervix is almost always a sign of trichomoniasis. This is often considered to be the most common curable sexually transmitted infection around the world.

It’s caused by the protozoan Trichomonas vaginalis (T. vaginalis). The time between exposure to the parasite and infection may span 5 to 28 days.

You may be more likely to develop strawberry cervix if you have:

  • a history of sexually transmitted infections
  • had a previous bout of trichomoniasis
  • multiple sexual partners
  • unprotected vaginal, oral, or anal sex

How is it diagnosed?

Strawberry cervix is rarely seen during a routine pelvic exam but can be detected during colposcopy. This procedure can be performed in about 20 minutes in your doctor’s office, in much the same way your usual pelvic exam is done. The colposcope helps to provide a clear look at your cervix.

At the same time, your doctor might swab your vagina for a sample of vaginal fluid for further testing.

Normal vaginal fluid has a fine, granular appearance. Creamy or bubbly discharge isn’t normal. Your doctor will want to consider and rule out other possible causes for your symptoms.

Strawberry cervix indicates a diagnosis of trichomoniasis. Other laboratory tests that can help confirm this include:

  • pH-level test: Trichomoniasis usually, but not always, causes pH levels to rise.
  • whiff test: In about half of women, trichomoniasis causes a “fishy” odor.
  • wet mount: Your doctor will examine your vaginal fluid under a microscope. If it contains squamous vaginal epithelial cells with sharply defined borders, visible nuclei, and a relatively clean appearance, it indicates trichomoniasis. Sometimes the parasite itself can be seen.

These tests can also help rule out other conditions, such as bacterial vaginosis and vulvovaginal candidiasis, which exhibit some of the same symptoms.

What is the treatment?

Trichomoniasis is treated with oral antibiotics metronidazole (Flagyl) or tinidazole (Tindamax):

These may be taken in one large dose. If your body doesn’t respond to the medication, your doctor may prescribe a higher dose.

You doctor may caution you to avoid alcohol for 24 to 72 hours after taking the medication.

Metronidazole is the medication of choice to use during pregnancy.

You should abstain from sexual relations until all your symptoms are gone. To prevent reinfection, your sexual partners should be tested and treated, even if they have no symptoms.

Are there any potential complications?

If left untreated, trichomoniasis can increase your risk of complications, including:

In women who are pregnant, trichomoniasis can cause premature delivery or low birth weight. You can also transmit the infection to your baby during delivery. This can lead to breathing difficulties, fever, and urinary tract infection.

Without treatment, you’re likely to pass the infection along to sexual partners.

What’s the outlook?

One dose of metronidazole or tinidazole can cure trichomoniasis. Symptoms usually clear up within a week.

However, about 1 in 5 people get reinfected within 3 months of treatment. That’s why it’s so important to wait until all your symptoms are gone before having sex again. It’s crucial to have your partner tested and treated, too.

In the United States, there are about 7.4 million new cases of trichomoniasis every year:

  • About half of women with trichomoniasis have symptoms.
  • Most men have no symptoms.

But asymptomatic people can carry and transmit the infection. You can help lower the risk of getting or transmitting the infection by using condoms every time you have sex.

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