Differential Diagnosis for 17 Year Old Female with Incontinence, Abdominal Pain, Dyspareunia, Discharge, and History of Recurrent Herpes

• Single Most Likely Diagnosis
  • Pelvic Inflammatory Disease (PID): This condition is likely given the combination of abdominal pain, dyspareunia, and discharge, especially in a sexually active young woman with a history of recurrent herpes, which increases the risk of other sexually transmitted infections (STIs) that can lead to PID.
• Other Likely Diagnoses
  • Urinary Tract Infection (UTI): Symptoms such as incontinence and abdominal pain could be indicative of a UTI, which is common in young women and can be related to sexual activity.
  • Endometriosis: Dyspareunia and abdominal pain are key symptoms of endometriosis, a condition where tissue similar to the lining inside the uterus is found outside the uterus, leading to pain and discomfort.
  • Vulvovaginitis: Given the discharge and history of herpes, vulvovaginitis (inflammation of the vulva and vagina) could be a consideration, especially if caused by yeast, bacteria, or other viral infections.
• Do Not Miss Diagnoses
  • Ectopic Pregnancy: Although less likely if the patient is using contraception or not sexually active, an ectopic pregnancy can present with abdominal pain and must be ruled out due to its potential for severe consequences.
  • Ovarian Torsion: Sudden, severe abdominal pain could indicate ovarian torsion, a condition requiring immediate surgical intervention to preserve ovarian function.
  • Appendicitis: Abdominal pain, especially if localized to the lower right quadrant, could indicate appendicitis, which requires prompt surgical treatment.
• Rare Diagnoses
  • Tuberculosis (TB) of the Genital Tract: Although rare, TB can affect the genital tract and cause symptoms such as abdominal pain, discharge, and infertility.
  • Lymphogranuloma Venereum (LGV): A type of STI caused by certain strains of Chlamydia trachomatis, LGV can lead to symptoms like discharge, abdominal pain, and complications if not treated properly.
  • Genital Fistula: An abnormal connection between the vagina and another organ (like the bladder or intestine), which could explain incontinence, is a rare condition often associated with obstetric trauma, surgery, or advanced pelvic disease.