A 28-year-old nulliparous woman being evaluated for infertility comes to the office due to clear vaginal discharge for the past 2 days. The patient and her partner have intercourse every other day and have been trying to conceive for the past 7 months. Menstrual cycles occur every 29 days with 4 days of flow. Last week, she took penicillin for a sore throat. The patient has no medical issues and has had no surgeries. She takes a daily prenatal vitamin. Pelvic examination shows clear mucus at the cervical os. Which of the following is the most likely explanation for this patient's discharge?

Question

A 28-year-old nulliparous woman being evaluated for infertility comes to the office due to clear vaginal discharge for the past 2 days.  The patient and her partner have intercourse every other day and have been trying to conceive for the past 7 months.  Menstrual cycles occur every 29 days with 4 days of flow.  Last week, she took penicillin for a sore throat.  The patient has no medical issues and has had no surgeries.  She takes a daily prenatal vitamin.  Pelvic examination shows clear mucus at the cervical os.  Which of the following is the most likely explanation for this patient's discharge?

Quizplus · Accepted Answer

11ec25c8_d9da_6c43_bc81_3f15c62184d4_MD0003_00 Ovulation marks the transition from the follicular phase of the menstrual cycle to the luteal phase. This occurs midway through the woman's cycle and is preceded by an LH surge, the hormone typically detected by commercial ovulation kits. Couples trying to conceive can attempt to schedule intercourse immediately prior to ovulation without LH measurements by monitoring physiologic factors such as cervical mucus and basal body temperature. Cervical mucus secretion close to ovulation (late follicular phase) increases in quantity and can be perceived by patients as vaginal discharge. This mucus is clear, elastic, thin in consistency, and described similar in appearance to an uncooked egg white. It is thought to facilitate sperm transport into the uterus for conception. After ovulation occurs, the mucus becomes thick and less hospitable to sperm. (Choice A) Bacterial vaginosis typically causes a thin white discharge with an odor rather than clear cervical mucus. (Choice B) Candidiasis typically causes a thick white to yellow discharge and mucosal erythema rather than clear cervical discharge. (Choice C) A cervical mucus plug serves as barrier to ascending infection during pregnancy. This brown, red, or yellowish thick mucus is typically shed before or during labor. (Choice D) Chlamydia cervicitis can present with a mucopurulent cervical discharge and a friable cervix rather than clear cervical secretions. (Choice F) Trichomoniasis causes yellow-green malodorous discharge rather than clear cervical mucus. Educational objective: Cervical mucus just prior to ovulation is profuse, clear, thin, and corresponds with an LH surge. This physiologic finding is not an indication of infection. References: Timed intercourse for couples trying to conceive. (http://www.ncbi.nlm.nih.gov/pubmed/25775926)

A 28-Year-Old Nulliparous Woman Being Evaluated for Infertility Comes to the Office