Differential Diagnosis for Vaginal Irritation and Discharge
The patient presents with vaginal irritation, feeling raw when wiping, pimples on vaginal glands or lips, yellow discharge on panty liner, no active discharge, and burning in the anal area when wiping after urinating. Based on these symptoms, the following differential diagnoses are considered:
- Single Most Likely Diagnosis
- Vulvovaginal Candidiasis (Yeast Infection): This condition is characterized by vaginal irritation, itching, burning, and a white or yellow discharge. The presence of pimples on the vaginal lips and the feeling of rawness when wiping are consistent with a yeast infection. The symptoms started over the weekend, which could suggest an opportunistic infection.
- Other Likely Diagnoses
- Bacterial Vaginosis (BV): Although BV typically presents with a fishy odor and a thin, white or gray discharge, some cases can have a yellow discharge. The absence of active discharge and the presence of vaginal irritation could still align with BV.
- Contact Dermatitis or Irritant Dermatitis: This could be due to an allergic reaction or irritation from soaps, douches, or other products, leading to vaginal irritation, redness, and possibly pimples on the vaginal area.
- Urinary Tract Infection (UTI): The burning sensation in the anal area when wiping after urinating might suggest a UTI, especially if the infection has spread to the urethra. However, typical UTI symptoms like dysuria, frequency, and urgency are not mentioned.
- Do Not Miss Diagnoses
- Sexually Transmitted Infections (STIs) like Herpes Simplex Virus (HSV) or Syphilis: These infections can cause genital ulcers, which might be perceived as pimples, and can lead to significant morbidity if not treated promptly.
- Cervical or Endometrial Cancer: Although rare and less likely in the absence of other symptoms like abnormal vaginal bleeding, these conditions should be considered, especially if the patient is overdue for a cervical screening or has risk factors.
- Rare Diagnoses
- Lichen Sclerosus or Lichen Planus: These are chronic skin conditions that can affect the genital area, causing itching, burning, and skin changes, but they are less common and might not fully explain the acute onset of symptoms.
- Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by vaginal inflammation and a yellow or green discharge, but it's less likely given the specific combination of symptoms presented.