Vaginitis Differential Diagnosis

The differential diagnosis for vaginitis can be organized into the following categories:

• Single Most Likely Diagnosis

  • Bacterial vaginosis: This is the most common cause of vaginitis, characterized by an imbalance of the normal vaginal flora, leading to symptoms such as malodorous discharge, itching, and irritation. The justification for this being the single most likely diagnosis is its high prevalence among women of reproductive age.

• Other Likely Diagnoses

  • Vulvovaginal candidiasis (yeast infection): Caused by Candida species, this condition is common, especially in women who are pregnant, diabetic, or using antibiotics. Symptoms include itching, burning, and a thick, white discharge.
  • Trichomoniasis: A sexually transmitted infection caused by the parasite Trichomonas vaginalis, characterized by a frothy, greenish-yellow vaginal discharge, itching, and irritation.
  • Atrophic vaginitis: Common in postmenopausal women due to decreased estrogen levels, leading to thinning and drying of the vaginal walls, causing symptoms like itching, burning, and pain during intercourse.

• Do Not Miss Diagnoses

  • Gonorrhea and chlamydia: These are sexually transmitted infections that can cause vaginitis symptoms. They are crucial to diagnose and treat promptly to prevent complications like pelvic inflammatory disease (PID), infertility, and increased risk of HIV transmission.
  • Herpes simplex virus (HSV): Although primarily known for causing genital ulcers, HSV can also lead to vaginitis-like symptoms. Accurate diagnosis is essential for appropriate management and to prevent transmission.
  • Syphilis: A sexually transmitted infection with various stages, including a primary stage that can present with a genital ulcer, which might be mistaken for vaginitis. Missing this diagnosis can lead to severe complications if left untreated.

• Rare Diagnoses

  • Desquamative inflammatory vaginitis (DIV): A rare condition characterized by a purulent vaginal discharge and significant inflammation of the vaginal mucosa. The exact cause is unknown, but it is thought to be related to an autoimmune process or an allergic reaction.
  • Vaginal tuberculosis: A rare condition in many parts of the world, but more common in areas with high TB prevalence. It can cause chronic vaginitis symptoms, among other systemic symptoms.
  • Foreign body vaginitis: Typically seen in young girls who insert foreign objects into their vagina, leading to a chronic inflammatory response and discharge.