Differential Diagnosis for a 19-year-old Female Patient with Mild Abdominal Pain and Malodorous Vaginal Discharge
Single Most Likely Diagnosis
- Bacterial Vaginosis (BV): The patient's complaint of malodorous vaginal discharge is a classic symptom of BV, which is a common condition in women of reproductive age. The recent history of a potentially new sexual exposure due to her boyfriend's infidelity also increases the likelihood of acquiring an STI, but BV is not exclusively an STI, making it a plausible diagnosis given the symptoms.
- Chlamydia: Given the patient's concern about being infected with chlamydia due to her boyfriend's cheating, and considering chlamydia is one of the most common STIs, especially in young, sexually active individuals, it stands as a highly likely diagnosis. Chlamydia can cause symptoms like abdominal pain and abnormal vaginal discharge.
Other Likely Diagnoses
- Gonorrhea: Similar to chlamydia, gonorrhea is a common STI that can cause symptoms such as abdominal pain and vaginal discharge. The patient's recent sexual history and her concern about STIs make gonorrhea a plausible diagnosis.
- Trichomoniasis: This STI can cause a malodorous, frothy vaginal discharge, which aligns with the patient's symptoms. It's another common STI that should be considered, especially given the patient's sexual history.
- Pelvic Inflammatory Disease (PID): While PID is a complication of untreated STIs like chlamydia and gonorrhea, the patient's symptoms of mild abdominal pain could be indicative of early PID, especially if she has been infected with an STI.
Do Not Miss Diagnoses
- Syphilis: Although less common than other STIs, syphilis is a critical diagnosis not to miss due to its potential for severe complications if left untreated, including neurological and cardiovascular problems. The primary stage of syphilis can present with a painless chancre, but in women, it can also cause cervical or vaginal lesions, which might lead to abnormal discharge.
- Human Immunodeficiency Virus (HIV): Given the patient's recent exposure to a potentially infected partner, testing for HIV is crucial. Early detection and treatment of HIV can significantly improve outcomes, making it a diagnosis that must not be missed.
Rare Diagnoses
- Genital Herpes: While not as common as other STIs in terms of causing chronic vaginal discharge, genital herpes can cause painful lesions and potentially some discharge. It's less likely given the description of symptoms but should be considered, especially if the patient reports any lesions or ulcers.
- Vulvovaginal Candidiasis: Although more commonly associated with a yeast infection, it could be considered in the differential, especially if the discharge is described as thick and cottage cheese-like. However, the malodorous nature of the discharge and the abdominal pain make this a less likely diagnosis compared to bacterial or STI causes.