Differential Diagnosis for Vulvovaginal Pruritus

The patient's symptoms of vaginal discharge associated with burning, irritation, and pruritus, along with the physical examination findings, suggest an infectious cause. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • B. Candidiasis: This is the most common infectious cause of vulvovaginal pruritus, especially given the thick white adherent discharge and the absence of cervical motion tenderness or uterine tenderness. Candidiasis is more common in women who are sexually active and can be triggered by various factors including antibiotic use, hormonal changes, and immune system alterations.

• Other Likely Diagnoses

  • A. Bacterial Vaginosis: Although less likely given the description of the discharge as thick and white (bacterial vaginosis typically presents with a thin, homogeneous, grayish-white discharge), it remains a possibility and should be considered, especially if the patient's symptoms and discharge characteristics do not fully align with candidiasis.
  • D. Chlamydia trachomatis: While Chlamydia can cause cervicitis and urethritis, it is less commonly associated with the symptoms of vulvovaginal pruritus and thick white discharge. However, given the patient's sexual activity, it should be considered in the differential diagnosis.

• Do Not Miss Diagnoses

  • C. N. gonorrhoeae: Gonorrhea can cause severe infections, including pelvic inflammatory disease (PID), which would present with cervical motion tenderness and uterine tenderness, not noted in this case. However, it's crucial to consider and rule out gonorrhea due to its potential for severe complications, even though the symptoms do not perfectly align.
  • Herpes Simplex Virus (HSV): Although not listed among the choices, HSV can cause vulvar ulcers and significant discomfort. It's a critical diagnosis not to miss due to its implications for patient care and potential for neonatal transmission.

• Rare Diagnoses

  • Trichomoniasis: Caused by the protozoan Trichomonas vaginalis, this infection can lead to vaginitis but is less common and typically presents with a frothy, greenish-yellow discharge, which does not match the patient's symptoms.
  • Other fungal infections: While candidiasis is the most common fungal cause, other fungi can rarely cause similar symptoms and should be considered if initial treatments for candidiasis fail and the diagnosis remains unclear.