A 28-year-old primigravida at 10 weeks of gestation is evaluated during her first prenatal visit. She feels well and reports no vaginal discharge, pelvic pain, or dysuria. Her past medical history is unremarkable, and she takes a daily prenatal vitamin. Vital signs are within normal limits. A pelvic examination demonstrates a normal-appearing cervix with no evidence of inflammation or abnormal discharge. Routine prenatal laboratory screening is performed. The nucleic acid amplification test (NAAT) from a vaginal swab is positive for *Chlamydia trachomatis* and negative for *Neisseria gonorrhoeae*. Which of the following is the most appropriate next step in the management of this patient?
- Single dose of oral azithromycinAnswer
- BOral doxycycline therapy for one week
- CConcurrent intramuscular ceftriaxone and oral azithromycin
- DObservation with no pharmacologic intervention
- EIntravaginal clindamycin therapy
Answer
Single dose of oral azithromycin
The patient has a confirmed, asymptomatic *Chlamydia trachomatis* infection. In pregnant women, untreated chlamydial infection carries significant risks, including preterm premature rupture of membranes, preterm labor, and transmission to the neonate (causing conjunctivitis or pneumonia). Therefore, treatment is absolutely indicated. The preferred treatment for *Chlamydia trachomatis* during pregnancy is a single dose of oral azithromycin, as it is safe for the fetus (pregnancy class B) and ensures high compliance. Amoxicillin is a secondary alternative.
Step-by-Step Solution
Key Concept
Management of Chlamydia trachomatis infection during pregnancy