Differential Diagnosis for Erythematous Friable Cervix with Mucopurulent Discharge
Single Most Likely Diagnosis
- Chlamydia trachomatis: This is the most likely diagnosis due to the presence of mucopurulent discharge from the os, yellow vaginal discharge, and an erythematous friable cervix, which are all characteristic signs of chlamydial cervicitis. The absence of cervical motion tenderness also supports this diagnosis, as chlamydial infections tend to cause less pelvic inflammatory disease (PID) symptoms compared to gonococcal infections.
Other Likely Diagnoses
- Neisseria gonorrhoeae: Although the absence of cervical motion tenderness makes this less likely, gonococcal cervicitis can still present with similar symptoms, including mucopurulent discharge and an erythematous friable cervix. The presence of yellow vaginal discharge also aligns with gonococcal infection.
- Trichomonas vaginalis: This infection can cause a yellow, frothy vaginal discharge and cervicitis, which might present with an erythematous and friable cervix. However, the discharge in trichomoniasis is typically more malodorous and frothy compared to the discharge seen in chlamydial or gonococcal infections.
Do Not Miss Diagnoses
- Pelvic Inflammatory Disease (PID): Although the patient does not have cervical motion tenderness, PID is a critical diagnosis not to miss due to its potential for long-term complications, including infertility and chronic pelvic pain. The presence of mucopurulent discharge and an erythematous friable cervix could be indicative of PID, especially if the patient has risk factors or if the symptoms worsen.
- Cervical Cancer: While less likely given the acute presentation, any abnormal cervical appearance, including an erythematous friable cervix, warrants consideration of cervical cancer, particularly in patients who are behind on screening or have risk factors.
Rare Diagnoses
- Herpes Simplex Virus (HSV): Although HSV typically causes vesicular or ulcerative lesions, which are not mentioned, it can cause cervicitis. The presentation would be atypical without lesions, making this a less likely but not impossible diagnosis.
- Other bacterial infections (e.g., Mycoplasma genitalium): These can cause cervicitis with similar symptoms but are less common and might be considered if first-line treatments for chlamydia and gonorrhea fail.