Differential Diagnosis for 30-year-old Female with Vaginal Itching and Irritation

• Single most likely diagnosis:
  • Vaginal candidiasis (yeast infection): The patient's symptoms of vaginal itching and irritation, especially after recent antibiotic use, are classic for a yeast infection. The patient is also requesting fluconazole, which is a common treatment for this condition.
• Other Likely diagnoses:
  • Bacterial vaginosis: Although the patient's symptoms are more suggestive of a yeast infection, bacterial vaginosis is another common cause of vaginal itching and irritation.
  • Trichomoniasis: This is a sexually transmitted infection that can cause vaginal itching and irritation, although it is less likely given the patient's recent antibiotic use and symptoms suggestive of a yeast infection.
  • Contact dermatitis: The patient may have developed contact dermatitis due to irritation from the antibiotic or other substances, which could cause vaginal itching and irritation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Toxic shock syndrome: Although rare, toxic shock syndrome is a life-threatening condition that can occur in women, especially in the setting of recent antibiotic use or infection. The patient's fever and sore throat could be indicative of a more serious infection.
  • Pelvic inflammatory disease (PID): PID is a serious infection of the female reproductive organs that can cause vaginal itching and irritation, as well as fever and sore throat. It is essential to consider PID in the differential diagnosis, especially if the patient has a history of sexually transmitted infections.
  • Stevens-Johnson syndrome: This is a rare but life-threatening condition that can occur as a reaction to certain medications, including antibiotics. The patient's recent antibiotic use and symptoms of fever and sore throat could be indicative of Stevens-Johnson syndrome.
• Rare diagnoses:
  • Lichen planus: This is a rare condition that can cause vaginal itching and irritation, although it is less likely given the patient's symptoms and recent antibiotic use.
  • Lichen sclerosus: This is another rare condition that can cause vaginal itching and irritation, although it is less common in women of the patient's age group.