Differential Diagnosis for Vaginal Odor with Negative Testing

• Single Most Likely Diagnosis
  • Bacterial Vaginosis (BV): Although testing may be negative, BV is a common cause of vaginal odor and can be difficult to diagnose. It's possible that the testing may not have been sensitive enough or the sample may not have been collected correctly.
• Other Likely Diagnoses
  • Vulvovaginal Candidiasis: A yeast infection can cause a strong odor, and testing may not always detect the fungus.
  • Trichomoniasis: This sexually transmitted infection can cause a foul odor, and testing may be negative if the sample is not collected correctly.
  • Poor Hygiene: Infrequent showering or bathing, or not changing underwear regularly can contribute to vaginal odor.
  • Dietary Factors: Consuming foods with strong odors, such as fish or garlic, can cause vaginal odor.
• Do Not Miss Diagnoses
  • Cervical Cancer: Although rare, cervical cancer can cause a foul odor, and it's essential to rule out this diagnosis.
  • Endometrial Cancer: Abnormal vaginal bleeding and odor can be symptoms of endometrial cancer.
  • Pelvic Inflammatory Disease (PID): PID can cause a foul odor, and if left untreated, can lead to serious complications.
• Rare Diagnoses
  • Foreign Body: A forgotten tampon or other object in the vagina can cause a strong odor.
  • Vestibular Papillomatosis: A rare condition that causes small, finger-like growths on the vulva, which can lead to a strong odor.
  • Ectopic Pregnancy: Although rare, an ectopic pregnancy can cause a foul odor, and it's essential to consider this diagnosis in women of childbearing age.