Differential Diagnosis for Vulvovaginitis
Single Most Likely Diagnosis
- Candidal vulvovaginitis: This is the most common cause of vulvovaginitis, especially if the patient presents with a thick, white discharge and itching. The symptoms and presentation are classic for a fungal infection, making this the top consideration.
Other Likely Diagnoses
- Bacterial vaginosis: This condition is characterized by an imbalance of the normal vaginal flora, leading to symptoms like fish-like odor and thin, white or gray discharge. It's a common cause of vulvovaginitis and should be considered, especially if the discharge doesn't seem fungal.
- Trichomoniasis: A sexually transmitted infection caused by the parasite Trichomonas vaginalis, it can cause vaginitis with symptoms including frothy discharge, itching, and irritation.
- Atrophic vaginosis: This condition occurs due to a decrease in estrogen levels, leading to thinning and drying of the vaginal tissue, which can cause symptoms similar to vulvovaginitis.
Do Not Miss Diagnoses
- Herpes simplex virus (HSV): Although less common than other causes, HSV can cause severe vulvovaginitis with painful lesions. Missing this diagnosis could lead to significant morbidity and the potential for transmission.
- Syphilis: Another sexually transmitted infection that can cause vulvovaginitis, syphilis is critical to diagnose early due to its potential for serious complications if left untreated.
- Gonorrhea and Chlamydia: These sexually transmitted infections can also cause symptoms of vulvovaginitis and are crucial to diagnose to prevent long-term complications like infertility.
Rare Diagnoses
- Desquamative inflammatory vaginitis (DIV): A rare condition characterized by a puruning vaginal discharge and significant inflammation. It's an important consideration in cases where common causes have been ruled out.
- Vaginal lichen planus: An autoimmune condition that can affect the vagina, causing inflammation and scarring. It's a rare cause of vulvovaginitis but should be considered in atypical cases.
- Vaginal cancer: Although extremely rare, any persistent or unexplained vaginal symptoms could potentially be a sign of a malignancy, making it essential to keep in the differential diagnosis, especially in older patients or those with risk factors.