Differential Diagnosis for Sarah's Symptoms
Single Most Likely Diagnosis
- Pelvic Inflammatory Disease (PID): This is the most likely diagnosis given Sarah's symptoms of lower abdominal pain, fever, unusual vaginal discharge, pain during intercourse, and spotting between periods, along with cervical motion tenderness and adnexal tenderness on examination. PID is a common condition in sexually active women, and Sarah's presentation is consistent with the classic symptoms of PID.
Other Likely Diagnoses
- Endometriosis: This condition can cause chronic pelvic pain, dyspareunia (pain during intercourse), and irregular menstrual bleeding, which overlap with some of Sarah's symptoms. However, the acute onset of fever and unusual vaginal discharge is less typical for endometriosis.
- Ovarian Cyst: Ovarian cysts can cause pelvic pain and can rupture, leading to acute symptoms. However, they typically do not cause fever or unusual vaginal discharge unless there is an associated infection.
- Ectopic Pregnancy: Although less likely given the absence of a reported missed period or positive pregnancy test, ectopic pregnancy can present with pelvic pain, spotting, and adnexal tenderness. It's a critical diagnosis to consider in any woman of childbearing age presenting with these symptoms.
Do Not Miss Diagnoses
- Ectopic Pregnancy: As mentioned, this is a critical diagnosis that must be ruled out due to its potential for severe morbidity and mortality if not promptly treated.
- Appendicitis: Although the symptoms can be somewhat different, appendicitis can present with lower abdominal pain, fever, and tenderness. It requires urgent surgical intervention.
- Septic Abortion: In the event of an incomplete or infected abortion, symptoms can include fever, abdominal pain, and vaginal discharge. This condition is life-threatening and requires immediate medical attention.
Rare Diagnoses
- Diverticulitis: This condition involves inflammation of the diverticula in the digestive tract and can cause lower abdominal pain and fever. However, it is less common in young women and typically does not cause vaginal discharge or cervical motion tenderness.
- Tuberculosis: Genital tuberculosis can cause chronic pelvic pain, infertility, and menstrual irregularities but is relatively rare in many parts of the world and would not typically present with the acute symptoms Sarah is experiencing.
- Malignancy: Ovarian or uterine cancer can cause pelvic pain and abnormal vaginal bleeding but is extremely rare in a 25-year-old woman and would not typically present with acute symptoms of fever and discharge.