Differential Diagnosis for Pelvic Exam Findings

The following differential diagnosis is based on the provided pelvic exam findings, which include labia minora and vestibule swelling with erythema, white discharge at the introitus and throughout the vagina, erythematous vaginal walls and cervix, a pH of 4.0, and no discharge from the os.

• Single Most Likely Diagnosis

  • Vulvovaginal Candidiasis: This condition is characterized by itching, burning, and redness of the vulva and vagina, along with a white, cottage cheese-like discharge. The symptoms and the normal pH of 4.0 support this diagnosis, as candidiasis typically does not alter the vaginal pH significantly.

• Other Likely Diagnoses

  • Bacterial Vaginosis (BV): Although the normal pH and the presence of a white discharge might suggest candidiasis, BV can sometimes present with a similar discharge and should be considered, especially if the discharge is homogeneous and there's a fishy odor, which isn't mentioned but could be a clue.
  • Trichomoniasis: This infection can cause vaginal discharge, erythema, and an elevated pH, but the pH of 4.0 in this case is lower than what is typically seen in trichomoniasis. However, it's still a consideration due to the presence of discharge and erythema.

• Do Not Miss Diagnoses

  • Pelvic Inflammatory Disease (PID): Although the findings do not strongly suggest PID (which typically presents with pelvic pain, fever, and purulent cervical discharge), it's crucial not to miss this diagnosis due to its potential for severe complications, including infertility and chronic pelvic pain. The absence of discharge from the os and the normal pH make this less likely, but it should be considered, especially if there's a history of sexually transmitted infections or other risk factors.
  • Sexually Transmitted Infections (STIs) like Gonorrhea or Chlamydia: These infections can present with a variety of symptoms, including discharge and erythema. While the specific findings here don't strongly suggest these infections, they are important to rule out due to their potential for serious complications.

• Rare Diagnoses

  • Desquamative Inflammatory Vaginitis (DIV): This is a rare condition characterized by a purulent vaginal discharge and significant inflammation of the vaginal walls. It could be considered if other diagnoses are ruled out and the patient's symptoms persist.
  • Vaginal Foreign Body: Although rare, a foreign body in the vagina can cause discharge, erythema, and other symptoms. This diagnosis should be considered if there's a history suggestive of a foreign body or if other diagnoses are ruled out.