Differential Diagnosis for Sarah's Symptoms
Based on Sarah's symptoms and examination findings, the following differential diagnoses are considered:
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. The presence of cervical motion tenderness and adnexal tenderness on examination further supports this diagnosis, as these are classic signs of PID.
Other Likely Diagnoses
- Endometriosis: This condition can cause lower abdominal pain, dyspareunia (pain during intercourse), and irregular menstrual bleeding, which align with some of Sarah's symptoms. However, the presence of fever and unusual vaginal discharge is less typical for endometriosis.
- Ovarian Cyst: Ovarian cysts can cause lower abdominal pain and adnexal tenderness. While they might not directly explain the fever or unusual discharge, they could be a contributing factor to her symptoms, especially if the cyst is ruptured or torsioned.
- Sexually Transmitted Infections (STIs) other than PID: STIs like gonorrhea or chlamydia can cause symptoms similar to PID, including unusual discharge and pain during intercourse. These infections might not always present with systemic symptoms like fever but can cause local inflammation.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although Sarah is sexually active and could be at risk for pregnancy, her symptoms of lower abdominal pain, spotting, and adnexal tenderness could also suggest an ectopic pregnancy, which is a medical emergency. The presence of fever might be less common but could occur if there's associated infection or rupture.
- Appendicitis: While the primary symptoms of appendicitis are abdominal pain (often starting around the navel and then moving to the lower right abdomen), fever, and loss of appetite, atypical presentations can occur, especially in women, where the pain might be more diffuse or localized to the lower abdomen, potentially mimicking gynecological conditions.
- Diverticulitis: This condition involves inflammation of the diverticula in the digestive tract and can cause lower abdominal pain, fever, and changes in bowel habits. Although less likely given Sarah's age and the nature of her symptoms, it's a condition that requires prompt medical attention.
Rare Diagnoses
- Malignancy (e.g., Ovarian or Cervical Cancer): While cancer is a rare cause of these symptoms in a young woman, it cannot be entirely ruled out, especially if there's a family history or other risk factors. The symptoms of cancer can be non-specific and might include abdominal pain, irregular vaginal bleeding, and weight loss.
- Tuberculosis: Genital tuberculosis can cause a variety of symptoms including abdominal pain, irregular menstrual bleeding, and infertility. It's more common in areas where TB is prevalent and might be considered in the differential diagnosis if Sarah has risk factors for TB exposure.