Differential Diagnosis for Vaginal Odor with No STI

• Single Most Likely Diagnosis
  • Bacterial Vaginosis (BV): This is the most common cause of vaginal odor, characterized by an imbalance of the normal vaginal flora, with a predominance of anaerobic bacteria. The typical symptoms include a fishy odor, thin homogeneous discharge, and an elevated pH.
• Other Likely Diagnoses
  • Vulvovaginal Candidiasis: A yeast infection that can cause a strong, unpleasant odor, often accompanied by itching, redness, and a thick, white discharge.
  • Trichomoniasis: Although less common than BV, this protozoal infection can cause a foul-smelling, greenish-yellow discharge.
  • Poor Hygiene: Infrequent bathing or using scented soaps can contribute to vaginal odor.
  • Forgotten Tampon or Other Foreign Body: A retained tampon or other object can cause a strong odor due to bacterial growth.
• Do Not Miss Diagnoses
  • Cervical or Endometrial Cancer: Although rare, these cancers can cause abnormal vaginal bleeding and discharge with a foul odor. Early detection is crucial for effective treatment.
  • Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs that can cause a foul odor, along with other symptoms like pelvic pain and fever.
  • Tuberculosis: A rare cause of vaginal discharge and odor, often accompanied by systemic symptoms like weight loss and night sweats.
• Rare Diagnoses
  • Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by a purulent discharge and vaginal odor, often accompanied by vaginal bleeding and pain.
  • Vaginal Fistula: An abnormal connection between the vagina and another organ, such as the intestine or bladder, which can cause a foul-smelling discharge.
  • Ectopic Pregnancy: A rare cause of vaginal bleeding and odor, often accompanied by abdominal pain and other symptoms of pregnancy.