Differential Diagnosis for White, Thick, Foul Smelling Discharge

• Single Most Likely Diagnosis
  • Bacterial Vaginosis: This condition is characterized by an imbalance in the vaginal microbiome, leading to an overgrowth of bacteria. It is the most common cause of vaginal discharge in women of reproductive age and is known for its thick, white, and foul-smelling nature.
• Other Likely Diagnoses
  • Yeast Infection (Candidiasis): A common fungal infection that can cause a thick, white discharge with a yeasty or sour smell. It's less likely than bacterial vaginosis to cause a foul smell but is still a common condition.
  • Trichomoniasis: A sexually transmitted infection caused by the parasite Trichomonas vaginalis. It can lead to a foul-smelling, greenish-yellow or white discharge.
  • Cervicitis: Inflammation of the cervix, often due to infection, which can cause a variety of discharge types, including thick and foul-smelling.
• Do Not Miss Diagnoses
  • Gonorrhea and Chlamydia: These sexually transmitted infections can cause discharge, though it's often more purulent or cloudy. Missing these diagnoses can lead to severe complications, including infertility and pelvic inflammatory disease.
  • Pelvic Inflammatory Disease (PID): A serious infection of the female reproductive organs that can cause a range of symptoms, including foul-smelling discharge. PID is a medical emergency due to the risk of infertility and chronic pelvic pain.
• Rare Diagnoses
  • Foreign Body: In rare cases, especially in children, a foreign body in the vagina can cause a foul-smelling discharge.
  • Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by a thick, yellowish discharge and significant inflammation of the vaginal walls.
  • Vaginal Cancer: Though extremely rare, any unusual or persistent vaginal discharge should be evaluated to rule out malignancy, especially in postmenopausal women or those with risk factors.