Differential Diagnosis for a Primigravida with Yellow Discharge

Given the patient's presentation, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Bacterial Vaginosis (BV): This is a common condition in pregnant women, characterized by an imbalance of the vaginal microbiome, leading to symptoms such as yellow discharge. The presence of yellow discharge in a pregnant woman, especially without other symptoms like itching or burning, could point towards BV.

• Other Likely Diagnoses

  • Trichomoniasis: A sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis, which can cause a yellow-green, frothy discharge.
  • Yeast Infection (Candidiasis): Although typically associated with a white, cottage cheese-like discharge, some cases can present with a yellowish tint, especially if there's a mixed infection.
  • Chlamydia: A common STI that can cause cervicitis, leading to abnormal discharge, though it's often asymptomatic.

• Do Not Miss Diagnoses

  • Gonorrhea: Another STI that can cause cervicitis and abnormal discharge. It's crucial to diagnose and treat gonorrhea promptly to prevent complications like pelvic inflammatory disease (PID) and potential harm to the fetus.
  • Syphilis: An STI that can have significant consequences for the fetus if left untreated, including congenital syphilis. Early detection and treatment are critical.
  • Group B Streptococcus (GBS) Infection: While GBS is more commonly associated with pregnancy complications like preterm labor and stillbirth, it can also cause symptoms like abnormal discharge in some cases.

• Rare Diagnoses

  • Herpes Simplex Virus (HSV): Typically causes genital ulcers but can also lead to abnormal discharge in some cases.
  • Human Papillomavirus (HPV): While primarily associated with cervical dysplasia and cancer, certain strains can cause symptoms like abnormal discharge.

EDD and Current GA Calculation

• Last Menstrual Period (LMP): June 17,2025
• Expected Date of Delivery (EDD): Assuming a regular 28-day menstrual cycle and ovulation on day 14, the EDD can be calculated as follows: June 17,2025 + 280 days = March 24,2026.
• Current Gestational Age (GA): As of the current date (assuming the response is being written on September 12,2025), the GA would be approximately 12 weeks, calculated from the LMP.

Management

1. Suspected STI:

   • Perform a thorough physical examination.
   • Collect specimens for STI testing (e.g., chlamydia, gonorrhea, trichomoniasis, syphilis).
   • Treat empirically based on symptoms and risk factors while awaiting test results, considering the potential consequences of untreated STIs in pregnancy.
   • Counsel on safe sex practices and the importance of partner notification and treatment.

2. Not Suspected on Physical Examination:

   • If the discharge is deemed non-pathological or not indicative of an STI, manage symptomatically.
   • Provide hygiene advice to help alleviate symptoms.
   • Consider a follow-up appointment to reassess if symptoms persist or worsen.

In all cases, maintaining open communication with the patient about her symptoms, the importance of prenatal care, and the need for any additional testing or treatment is crucial.