What is the likely diagnosis for a 30-year-old female with dysuria, urgency, and vaginal irritation, with a history of genital herpes and chlamydia, after starting a new sexual relationship?

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Last updated: May 15, 2025 • View editorial policy

Differential Diagnosis for a 30-year-old Female with Mild Intermittent Dysuria and Vaginal Irritation

  • Single most likely diagnosis: + Urinary Tract Infection (UTI): The patient's symptoms of mild intermittent dysuria and urgency are classic for a UTI, which is a common condition in sexually active women.
  • Other Likely diagnoses: + Chlamydia or Gonorrhea: Given the patient's history of chlamydia and recent new sexual partner, it is possible that she has contracted another sexually transmitted infection (STI). + Trichomoniasis: This STI can cause vaginal irritation and dysuria, and is more likely in someone with a history of STIs. + Bacterial Vaginosis (BV) or Yeast Infection: These conditions can cause vaginal irritation and are common in women of reproductive age.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.): + Pelvic Inflammatory Disease (PID): Although less likely, PID is a serious condition that can cause significant morbidity if not treated promptly. The patient's history of chlamydia increases her risk. + Kidney Stones: While not directly related to the patient's sexual history, kidney stones can cause severe dysuria and urgency, and would require urgent medical attention.
  • Rare diagnoses: + Herpes Simplex Virus (HSV) recurrence: Although the patient has a history of genital herpes, she denies any recent outbreaks, making this a less likely diagnosis. + Lichen Planus or Lichen Sclerosus: These rare conditions can cause vaginal irritation and dysuria, but are less common and would require further evaluation to diagnose.

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