Differential Diagnosis for Patient with Painful Urination and Vaginal Discomfort

The patient presents with symptoms of painful burning urination, vaginal discomfort, itching, and discharge with a clumpy texture, which have been ongoing for 3 days. She is a 21-year-old female with a new sexual partner. Given these symptoms, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Vaginal Yeast Infection (Candidiasis): This is the most likely diagnosis given the symptoms of vaginal itching, discomfort, and a clumpy discharge, which are classic for a yeast infection. The recent introduction of a new sexual partner may also contribute to the development of a yeast infection due to potential changes in the vaginal flora.

• Other Likely Diagnoses

  • Bacterial Vaginosis (BV): Although the discharge in BV is typically described as thin and malodorous, some patients may present with symptoms overlapping those of a yeast infection, including vaginal discomfort and itching.
  • Trichomoniasis: This sexually transmitted infection can cause vaginal discharge, itching, and discomfort, as well as painful urination. The recent new sexual partner increases the likelihood of a sexually transmitted infection.
  • Chlamydia or Gonorrhea: These sexually transmitted infections can cause symptoms of painful urination and vaginal discharge. Given the patient's new sexual partner, these infections should be considered, especially if the patient is not using protection.

• Do Not Miss Diagnoses

  • Pelvic Inflammatory Disease (PID): While less likely given the symptoms, PID is a serious condition that can result from untreated sexually transmitted infections. It requires prompt treatment to prevent long-term complications such as infertility and chronic pelvic pain.
  • Herpes Simplex Virus (HSV): Genital herpes can cause painful lesions, itching, and burning during urination. Although the primary symptom is usually lesions, atypical presentations can occur, making it a "do not miss" diagnosis due to its potential for significant morbidity and the importance of antiviral treatment.

• Rare Diagnoses

  • Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by vaginal inflammation and a purulent discharge. It's less common and might be considered if other diagnoses are ruled out and symptoms persist.
  • Vaginal Cancer: Extremely rare in a 21-year-old, but any abnormal vaginal bleeding or persistent symptoms not explained by other diagnoses should prompt further investigation, including a thorough examination and potentially imaging or biopsy.