A Young Woman with Abdominal Pain

Abstract

Amanda, a 21-year-old student, attends a Sexual Health clinic because her boyfriend had been diagnosed as having urethral chlamydial infection 2 days previously. She tells you that for the past 2 weeks she has had intermittent lower abdominal discomfort, particularly on the right side. She also complains of persistent pain in the right upper abdomen, the pain radiating intermittently to the right shoulder, and being exacerbated by deep inspiration. Her periods have been regular, the most recent having been 14 days previously, and had been normal. She has not noticed increased vaginal discharge, but she has had some vaginal bleeding during the past week. There are no urinary or gastrointestinal symptoms. She has been in a regular relationship for 3 months, and she had had unprotected vaginal intercourse with her partner 2 days prior to her clinic attendance. Over the preceding 3 weeks she has had lower abdominal pain during intercourse. For 5 years she has used the combined oral contraceptive, and she has not missed any pills in the recent past. Her general health has been good, and she has not had any serious illnesses in the past.