A febrile 21-year-old woman presents with lower abdominal pain and acute pain during intercourse. Which condition is most likely?

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Multiple Choice

A febrile 21-year-old woman presents with lower abdominal pain and acute pain during intercourse. Which condition is most likely?

Pelvic inflammatory disease is being tested when fever accompanies lower abdominal pain in a sexually active young woman and there is pain with intercourse. This pattern points to inflammation of the upper female genital tract—cervix, uterus, and especially the fallopian tubes (salpingitis) due to ascending infection from sexually transmitted organisms such as gonorrhea or chlamydia. The fever reflects systemic involvement, and dyspareunia often occurs with pelvic inflammatory processes because of irritation and inflammation of the pelvic organs. Why the others fit less well: an ectopic pregnancy would typically come with a positive pregnancy test and may present with unilateral pain and vaginal bleeding, not fever as a prominent feature. Acute appendicitis usually causes focal abdominal pain with right lower quadrant tenderness and peritoneal signs, and pain during intercourse isn’t a core part of that presentation. Ovarian torsion presents as sudden, severe unilateral pelvic pain with nausea or vomiting and is not usually associated with fever or dyspareunia. In practice, this clinical picture makes PID the most likely diagnosis, and management involves prompt empiric antibiotics to cover the common sexually transmitted pathogens, with evaluation for pregnancy and consideration of STI testing and partner treatment.

Pelvic inflammatory disease is being tested when fever accompanies lower abdominal pain in a sexually active young woman and there is pain with intercourse. This pattern points to inflammation of the upper female genital tract—cervix, uterus, and especially the fallopian tubes (salpingitis) due to ascending infection from sexually transmitted organisms such as gonorrhea or chlamydia. The fever reflects systemic involvement, and dyspareunia often occurs with pelvic inflammatory processes because of irritation and inflammation of the pelvic organs.

Why the others fit less well: an ectopic pregnancy would typically come with a positive pregnancy test and may present with unilateral pain and vaginal bleeding, not fever as a prominent feature. Acute appendicitis usually causes focal abdominal pain with right lower quadrant tenderness and peritoneal signs, and pain during intercourse isn’t a core part of that presentation. Ovarian torsion presents as sudden, severe unilateral pelvic pain with nausea or vomiting and is not usually associated with fever or dyspareunia.

In practice, this clinical picture makes PID the most likely diagnosis, and management involves prompt empiric antibiotics to cover the common sexually transmitted pathogens, with evaluation for pregnancy and consideration of STI testing and partner treatment.

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