Differential Diagnosis for Vaginal Discharge and Itching

Single Most Likely Diagnosis

• Bacterial Vaginosis (BV): This is the most common cause of vaginal discharge in women of reproductive age. The patient's symptoms of increased vaginal discharge and itching, along with a history of unprotected sexual intercourse, support this diagnosis. BV is characterized by an imbalance of the normal vaginal flora, with a decrease in lactobacilli and an increase in anaerobic bacteria.

Other Likely Diagnoses

• Vaginal Candidiasis (Yeast Infection): This is another common cause of vaginal itching and discharge. The patient's symptoms of itching and discharge could be consistent with a yeast infection, especially if the discharge is thick and white.
• Trichomoniasis: This is a sexually transmitted infection that can cause vaginal discharge, itching, and irritation. The patient's history of unprotected sexual intercourse increases the likelihood of this diagnosis.
• Chlamydia or Gonorrhea: These are sexually transmitted infections that can cause vaginal discharge and itching. The patient's history of unprotected sexual intercourse and lack of menstrual period (which could indicate pregnancy or other hormonal imbalances) make these diagnoses possible.

Do Not Miss Diagnoses

• Pelvic Inflammatory Disease (PID): This is a serious condition that can occur if a sexually transmitted infection is left untreated. PID can cause significant morbidity, including infertility and chronic pelvic pain. The patient's symptoms of vaginal discharge and itching, along with a history of unprotected sexual intercourse, make PID a "do not miss" diagnosis.
• Ectopic Pregnancy: Given the patient's report of unprotected sexual intercourse and lack of menstrual period, ectopic pregnancy must be considered. This is a life-threatening condition that requires immediate medical attention.
• Cervical Cancer: Although less likely, cervical cancer can cause abnormal vaginal bleeding or discharge. Given the patient's age and sexual activity, it is essential to consider this diagnosis and ensure the patient is up to date on cervical cancer screening.

Rare Diagnoses

• Desquamative Inflammatory Vaginitis (DIV): This is a rare condition characterized by vaginal inflammation and discharge. It is often associated with other autoimmune or inflammatory conditions.
• Vaginal Cancer: This is a rare type of cancer that can cause abnormal vaginal bleeding or discharge. It is essential to consider this diagnosis, especially if the patient has a history of human papillomavirus (HPV) infection or other risk factors.