Differential Diagnosis for Shift in Vaginal Flora
- Single most likely diagnosis
- Bacterial Vaginosis (BV): This is the most likely diagnosis given the predominance of coccobacilli consistent with a shift in vaginal flora. BV is characterized by an imbalance in the normal vaginal microbiota, with a decrease in lactobacilli and an increase in bacteria such as Gardnerella vaginalis, Mycopopperone, and various anaer and aerobic bacteria, which are often coccobacilli in shape.
- Other Likely diagnoses
- Intermediate flora on Pap test: This condition refers to a finding on a Pap smear where the flora is not clearly normal (predominantly lactobacilli) but does not meet the full criteria for BV. It may represent a transitional state or a less severe imbalance in vaginal flora.
- Trichomoniasis: Although the primary clue for trichomoniasis is the presence of Trichomonas vaginalis, a shift in vaginal flora can sometimes be observed. However, the presence of coccobacilli is more suggestive of BV.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Gonococcal or Chlamydial infection: Although these infections are primarily identified through specific diagnostic tests (e.g., NAATs), a significant shift in vaginal flora could potentially be associated with these conditions, especially if there is an associated increase in inflammatory cells or other suggestive findings.
- Rare diagnoses
- Desquamative Inflammatory Vaginitis (DIV): This is a rare condition characterized by a significant inflammatory response and a shift in vaginal flora. However, it is less common than BV and typically presents with more pronounced symptoms and findings, including a significant increase in parabasal cells on a Pap smear.
- Vaginal candidiasis with atypical presentation: While Candida infections are common, an atypical presentation with a shift in flora towards coccobacilli would be unusual. Candidiasis is typically associated with budding yeast and pseudohyphae.