The diagnosis for this patient is Trichomoniasis. What are your two differential diagnoses?

Physical Exam:

Vital signs:

• Temperature is 36.8 C (98.3 F)
• Pulse is 80 beats/minute
• Respiratory rate is 14 breaths/minute
• Blood pressure is 128/76 mmHg
• Weight is 58.3 kg (128 lbs)
• Height is 160 cm (63 in)
• General: Well-developed, well-nourished, young female adult in no acute distress. Four-year-old son is in the room with her; patient is in the examination gown; she moves to sit on the table for the exam.
• Pain: 3/10 (abdomen)
• Neck: Supple, no bruits, lymphadenopathy, or thyromegaly.
• Lungs: Clear to percussion and auscultation.
• Heart: Regular rate and rhythm, no murmurs, rubs, gallops, or ectopy.
• Abdomen: Bowel sounds positive in all quadrants. Mid-epigastric area nontender; bilateral lower abdominal tenderness to palpation. Some areas of ecchymosis present, across mid and lower abdomen in varying shades—purple to blue, yellow, and green. No masses or organomegaly; no rebound tenderness or guarding, although she does flinch at initial touch.
• Back: No costovertebral tenderness or spine tenderness.
• Pelvic Exam: External genitalia normal without lesions; small amount of yellowish discharge with mild malodor in vagina. Cervix parous without obvious discharge; No cervical motion tenderness. Uterus is possibly borderline enlarged, without palpable masses or significant tenderness. Adnexae slightly tender to palpation bilaterally; ovaries palpated, no masses noted.
• Rectal exam: No masses; normal brown stool, negative hemoccult.
• Neurological: Normal gait and speech; deep tendon reflexes (DTRs) 2+ and equal.
• Extremities: No deformities, pulses 2+ and equal, ecchymoses on upper thighs and extensor aspects of forearms.
• Skin: No rashes; bruises as noted, from purple to bluish to green to yellow, in various stages of resolution.

Summary statement:

Ms. Bell is a 28-year-old female who presents with lower abdominal pain for two weeks: achy pelvic pain worsened by activity and sexual intercourse. She reports associated nausea, vomiting, and alternating loose stools and constipation. Her last menstrual period was four weeks ago; she is sexually active without birth control and has many psychosocial stressors and reports her husband drinks alcohol frequently but she rarely drinks. Physical examination is notable for lower abdominal tenderness, numerous ecchymoses across her abdomen and extremities, a small amount of yellowish, malodorous vaginal discharge, and no cervical motion tenderness.