A pregnant client at 28 weeks gestation presents to the prenatal clinic for a routine visit. During the assessment, the nurse notes several concerning findings that may indicate a sexually transmitted infection. Which assessment finding would be most indicative of a chlamydial infection?
1Painful vesicular lesions on the external genitalia
2Thick, white, cottage cheese-like vaginal discharge with intense itching
3Frothy, yellow-green vaginal discharge with a strong fishy odor
4Mucopurulent cervical discharge with possible urethral discharge✓ 정답
해설
Mucopurulent cervical discharge is the most characteristic finding for chlamydia. Other options describe herpes (vesicular lesions), candidiasis (white discharge), or trichomoniasis (frothy discharge).
Clinical Judgment
This question assesses Recognizing Cues. All the given options are symptoms related to genital infections, but each is specific to a different pathogen. The most characteristic sign of Chlamydia infection is Mucopurulent Cervical Discharge. This is a yellow or greenish, pus-like discharge from the cervix, which may be accompanied by urethral discharge. The other options are typical symptoms of herpes (1), candidiasis (2), and trichomoniasis (3).
Memory Tip:
A mnemonic for distinguishing STI symptoms: Chlamydia = Cervical Creamy pus. Or remember Mucopurulent for Most common STI.
KR vs US:
In Korea, prenatal testing includes Chlamydia screening, but in the US, Chlamydia screening is recommended for all pregnant women at the initial visit, and retesting is recommended at the end of the third trimester for high-risk groups (under 25, new sexual partner, etc.). Because asymptomatic infections are common, active screening is emphasized rather than relying on symptoms alone.
Clinical Practice Guide
If chlamydia infection is suspected in a pregnant woman, collect a cervical swab specimen and perform a NAAT (Nucleic Acid Amplification Test). The specimen must be collected before treatment. Treatment consists of a pregnancy-safe antibiotic (first-line: Azithromycin 1g single oral dose), and a test of cure should be performed 3-4 weeks after treatment to confirm success. Simultaneous treatment of sexual partners is essential.
Caution:
Chlamydia is very often asymptomatic. Therefore, you should not assume "it's fine because there are no symptoms." Also, option 3 (yellow-green frothy discharge) is a classic symptom of trichomoniasis, a common pitfall that can be confused with chlamydia.
Chlamydia trachomatis — One of the most common bacterial causes of sexually transmitted infections; in women, it causes cervicitis and urethritis, and is often asymptomatic.
Mucopurulent Cervical Discharge — Mucopurulent discharge from the cervix. A characteristic sign of chlamydia and gonorrhea infections.
Nucleic Acid Amplification Test — Most sensitive and specific test for chlamydia and gonorrhea. Performed on urine or cervical specimens.
Vertical Transmission — Vertical infection. The transmission of pathogens from the mother to the newborn during delivery. In the case of chlamydia, it can cause neonatal conjunctivitis or pneumonia.
Azithromycin — A macrolide antibiotic used as the first-line treatment for chlamydia infection during pregnancy. Typically administered as a single 1g oral dose.