A sexually active woman presents with lower abdominal pain, mucopurulent vaginal discharge, and cervicitis. The most likely diagnosis is:

• A. Chlamydia
• B. Pelvic inflammatory disease
• C. Bacterial vaginosis
• D. Gonorrhea

Answer: (D)

Gonorrheal infection is suggested by the combination of cervicitis with mucopurulent discharge in a sexually active patient. The purulent discharge reflects infection of the cervical glands, which is a classic presentation of Neisseria gonorrhoeae. This organism can ascend from the cervix to the upper genital tract, leading to pelvic inflammatory disease, which explains the lower abdominal pain.

Bacterial vaginosis typically presents with a thin, gray discharge and a fishy odor and does not usually cause cervicitis with purulent mucopurulent discharge. Chlamydia can cause cervicitis and can trigger PID, but the mucopurulent, purulent discharge is more characteristic of gonorrhea. Pelvic inflammatory disease is a syndrome of upper tract infection; while it accounts for abdominal pain, it is usually the consequence of an ascending gonococcal (or chlamydial) infection rather than the primary diagnosis suggested by the cervicitis with mucopurulent discharge.