Differential Diagnosis
The patient's presentation of abdominal pain, dyspareunia, nausea, suprapubic tenderness, scant purulent discharge from the cervical os, and positive cervical motion tenderness suggests a pelvic inflammatory disease (PID). The following differential diagnoses are considered:
- Single most likely diagnosis
- Pelvic Inflammatory Disease (PID): The combination of lower abdominal pain, dyspareunia, and positive cervical motion tenderness, along with the presence of purulent discharge, strongly suggests PID. The patient's symptoms and physical examination findings are consistent with this diagnosis.
- Other Likely diagnoses
- Endometriosis: Although the patient's symptoms could be consistent with endometriosis, the presence of purulent discharge and positive cervical motion tenderness makes PID more likely. Endometriosis typically presents with chronic pelvic pain, dysmenorrhea, and dyspareunia.
- Ovarian cyst or torsion: The patient's symptoms could be consistent with an ovarian cyst or torsion, but the transvaginal ultrasound showed no acute abnormality, making this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic pregnancy: Although the urine pregnancy test is negative, it is essential to consider ectopic pregnancy in any female patient of childbearing age presenting with abdominal pain and vaginal bleeding or discharge. A negative pregnancy test does not entirely rule out ectopic pregnancy, especially if the test was performed early in the presentation.
- Appendicitis: The patient's symptoms could be consistent with appendicitis, particularly the abdominal pain and nausea. However, the presence of purulent discharge and positive cervical motion tenderness makes PID more likely.
- Rare diagnoses
- Tubo-ovarian abscess: Although this is a possible complication of PID, it is less likely given the patient's presentation and the absence of a palpable mass on physical examination.
- Diverticulitis: The patient's symptoms could be consistent with diverticulitis, but the presence of purulent discharge and positive cervical motion tenderness makes PID more likely.
The most appropriate management for this patient's condition would be Azithromycin, doxycycline, and metronidazole, which is the recommended treatment for PID.