Differential Diagnosis for Persistent BV Symptoms

Single Most Likely Diagnosis

• Bacterial Vaginosis (BV) recurrence or persistence: This is the most likely diagnosis given the persistent symptoms of BV, which can recur due to incomplete treatment, resistance to antibiotics, or reinfection.

Other Likely Diagnoses

• Vulvovaginal Candidiasis: This condition can present with similar symptoms to BV, such as vaginal discharge and irritation, and is a common cause of vaginal infections.
• Trichomoniasis: A sexually transmitted infection that can cause vaginal discharge, itching, and irritation, similar to BV.
• Atrophic Vaginitis: A condition caused by decreased estrogen levels, leading to vaginal dryness, itching, and discharge, which can be mistaken for BV symptoms.

Do Not Miss Diagnoses

• Cervical Cancer: Although less likely, persistent vaginal symptoms could be a sign of cervical cancer, especially if accompanied by abnormal vaginal bleeding or pelvic pain.
• Pelvic Inflammatory Disease (PID): A serious infection of the female reproductive organs that can cause persistent vaginal symptoms, pelvic pain, and fever.
• Gonorrhea or Chlamydia: Sexually transmitted infections that can cause vaginal discharge, pelvic pain, and other symptoms similar to BV.

Rare Diagnoses

• Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by vaginal inflammation, discharge, and pain, which can be difficult to diagnose and treat.
• Vaginal Cancer: A rare type of cancer that can cause persistent vaginal symptoms, including discharge, bleeding, and pain.
• Lichen Planus or Lichen Sclerosus: Rare skin conditions that can affect the vulva and vagina, causing itching, burning, and discharge.