Differential Diagnosis for Moderate Wet Mount and Vaginal Itching, Irritation, and Burning

• Single Most Likely Diagnosis
  • Vaginal Yeast Infection (Candidiasis): This is the most common cause of vaginal itching, irritation, and burning, especially when accompanied by a moderate wet mount, which can indicate the presence of yeast.
• Other Likely Diagnoses
  • Bacterial Vaginosis (BV): Characterized by an imbalance in the natural bacterial flora of the vagina, leading to symptoms like itching, burning, and an abnormal vaginal discharge.
  • Trichomoniasis: A sexually transmitted infection caused by the parasite Trichomonas vaginalis, which can cause vaginal itching, burning, and irritation, along with an abnormal discharge.
  • Vaginal Atrophy: Common in postmenopausal women, it leads to thinning and drying of the vaginal walls, causing itching, burning, and irritation.
• Do Not Miss Diagnoses
  • Herpes Simplex Virus (HSV): Although less common, HSV can cause severe vaginal itching, burning, and irritation, along with painful blisters or ulcers. Missing this diagnosis could lead to significant morbidity and the risk of transmission.
  • Gonorrhea and Chlamydia: These sexually transmitted infections can cause symptoms similar to those described and, if left untreated, can lead to serious complications like pelvic inflammatory disease (PID).
• Rare Diagnoses
  • Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by severe vaginal inflammation, leading to itching, burning, and a purulent discharge.
  • Lichen Sclerosus: A chronic skin condition that can affect the vulva, causing itching, burning, and architectural changes to the vulvar skin.
  • Vulvar Cancer: Although extremely rare, any persistent or severe symptoms of vaginal itching, irritation, and burning, especially in older women, warrant a thorough examination to rule out vulvar cancer.