Differential Diagnosis for Vaginal Discharge
- Single most likely diagnosis
- Bacterial Vaginosis (BV): The patient's complaint of foul-smelling vaginal discharge, particularly after sexual contact and during menses, along with the presence of grayish, thin, malodorous discharge, is highly suggestive of BV. The absence of other symptoms such as pain, fever, or dysuria also supports this diagnosis.
- Other Likely diagnoses
- Vulvovaginal Candidiasis: Although less likely given the description of the discharge as thin and grayish, candidiasis could still be considered, especially if the patient has risk factors such as antibiotic use or diabetes.
- Trichomoniasis: This sexually transmitted infection can cause a foul-smelling discharge, but it often presents with other symptoms like dysuria or dyspareunia, which are absent in this case.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pelvic Inflammatory Disease (PID): Although the patient does not have symptoms like pain or fever, PID can sometimes present subtly, and missing the diagnosis could lead to serious complications like infertility or chronic pelvic pain.
- Cervical Cancer: While very unlikely given the patient's age and the absence of other symptoms or abnormal findings on speculum exam, any abnormal vaginal discharge warrants consideration of cervical cancer, especially if the patient is behind on screening.
- Rare diagnoses
- Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by vaginal discharge, often with a foul odor, but typically accompanied by other symptoms like vaginal burning or pain, which are not present in this case.
- Foreign Body: The presence of a foreign body in the vagina could cause a foul-smelling discharge, but this would be unusual in an adult without a history of inserting such an object.