Differential Diagnosis for 21-year-old Pregnant Female with Vaginal Itchiness and Labia Swelling

• Single most likely diagnosis:
  • Vulvar varicosities or vulvovaginitis: The patient's symptoms of vaginal itchiness, labia swelling, and pain, especially in the context of pregnancy, could be attributed to vulvar varicosities, which are more common in pregnancy due to increased venous pressure. Alternatively, a vulvovaginitis, which could be caused by various infectious agents, is also a strong consideration given the symptoms.
• Other Likely diagnoses:
  • Urinary Tract Infection (UTI): The symptom of burning with urination (dysuria) is highly suggestive of a UTI, which is more common during pregnancy due to physiological changes that can predispose to infection.
  • Yeast infection (Candidiasis): Although the patient reports no vaginal discharge, yeast infections can sometimes present with minimal or no discharge, especially in pregnant women, and are known to cause itchiness and irritation.
  • Contact dermatitis: This could be a consideration if the patient has recently used new soaps, detergents, or other products that might irritate the vulvar area.
• Do Not Miss diagnoses:
  • Herpes simplex virus (HSV) infection: Although less common, an HSV infection can present with severe pain, swelling, and sometimes systemic symptoms. Given the potential for neonatal herpes, which can be severe, it's crucial not to miss this diagnosis in a pregnant woman.
  • Syphilis: This sexually transmitted infection can cause a variety of symptoms, including genital ulcers and swelling, and is critical to diagnose due to the risk of congenital syphilis.
  • Necrotizing fasciitis: This is a rare but life-threatening condition that could present with severe pain, swelling, and systemic symptoms. It requires immediate medical attention.
• Rare diagnoses:
  • Lichen sclerosis: A chronic inflammatory skin condition that can cause itching, pain, and architectural changes to the vulva. It's less common and might not be the first consideration but should be kept in mind for persistent or unexplained symptoms.
  • Vulvar intraepithelial neoplasia or cancer: Although extremely rare in a 21-year-old, any persistent, unexplained vulvar lesion or symptoms should prompt a thorough evaluation to rule out malignancy.