Differential Diagnosis for Postcoital Bleeding
Single Most Likely Diagnosis
- Cervical Cancer: The presence of an ulcerative lesion on the posterior aspect of the cervix that bleeds with contact, along with postcoital bleeding, strongly suggests cervical cancer. The patient's history of HIV infection and stopping antiretroviral therapy increases her risk for cervical cancer due to immune suppression.
Other Likely Diagnoses
- Cervicitis: Inflammation of the cervix could cause postcoital bleeding and an ulcerative appearance. Given the patient's HIV status, opportunistic infections could be a cause.
- Genital Herpes: Although not directly mentioned, the ulcerative lesion could be indicative of a herpes outbreak, which can cause bleeding and is more common in immunocompromised individuals.
- Cervical Dysplasia: Abnormal cell growth on the cervix could lead to bleeding, especially after sexual intercourse, and is a precursor to cervical cancer.
Do Not Miss Diagnoses
- Pelvic Inflammatory Disease (PID): While the pelvic exam did not show significant tenderness, PID can cause bleeding and is a serious condition that requires prompt treatment, especially in someone with a history of HIV.
- Endometrial Cancer: Although less likely given the patient's age and presentation, endometrial cancer can cause postmenopausal or postcoital bleeding and should not be overlooked, especially with the patient's history of stopped antiretroviral therapy potentially affecting her immune status and cancer risk.
Rare Diagnoses
- Cervical Lymphoma: In immunocompromised patients, lymphoma can present in unusual ways, including as a cervical mass or ulceration.
- Tuberculous Cervicitis: In areas where tuberculosis is common, or in immunocompromised patients, TB can infect the cervix, leading to bleeding and ulceration.
- Cervical Metastasis: Metastasis to the cervix from other primary cancers is rare but could present with bleeding and should be considered in the differential diagnosis, especially if other symptoms or findings suggest a primary cancer elsewhere.