Differential Diagnosis for Vulva/Vaginal Discomfort

The patient presents with a complex history of recent antibiotic use, a reported yeast infection, symptoms of vulvar discomfort, and a partner with a history of herpes simplex virus type 1 (HSV-1). The symptoms include redness on the labia, discomfort, friction during intercourse, pain with urination, and white spots on the labia, along with a urinalysis showing leukocytes and blood.

• Single Most Likely Diagnosis

  • Vulvovaginal Candidiasis (Yeast Infection): Given the patient's report of a yeast infection and symptoms such as vulvar discomfort, redness, and white spots on the labia, this diagnosis is highly plausible. The recent use of antibiotics could have contributed to the development of a yeast infection by disrupting the normal vaginal flora.

• Other Likely Diagnoses

  • Herpes Simplex Virus (HSV) Infection: Although the patient's partner tested positive for HSV-1, and the patient has resumed sexual intercourse, the symptoms described (friction, discomfort, pain with urination) could be consistent with an HSV infection, especially if the patient has contracted the virus from her partner.
  • Contact Dermatitis or Irritant Dermatitis: The patient's symptoms of redness, discomfort, and friction, especially after resuming sexual intercourse, could suggest a form of dermatitis caused by an irritant or allergen.
  • Urinary Tract Infection (UTI): The presence of leukocytes and blood in the urinalysis, along with pain during urination, supports the possibility of a UTI, which could be contributing to the patient's discomfort.

• Do Not Miss Diagnoses

  • Sexually Transmitted Infections (STIs) Other Than HSV: Although the patient and her partner have undergone STI testing, it is crucial not to miss other potential STIs that could cause similar symptoms, such as gonorrhea, chlamydia, or syphilis.
  • Pelvic Inflammatory Disease (PID): This condition, often caused by STIs, can lead to severe consequences if not treated promptly, including infertility and chronic pelvic pain.
  • Vulvar Ulcers or Abscesses: These conditions could cause significant pain and discomfort and might require specific treatment, including drainage of an abscess.

• Rare Diagnoses

  • Lichen Sclerosus or Lichen Planus: These are chronic skin conditions that can affect the vulva, causing discomfort, itching, and white patches, but they are less common and might not be the first consideration given the patient's recent history and symptoms.
  • Vulvar Cancer: Although extremely rare and unlikely given the patient's age and presentation, any persistent or unexplained vulvar lesion or symptom warrants thorough investigation to rule out malignancy.