Differential Diagnosis for Purulent Discharge from Vagina
Single Most Likely Diagnosis
- Bacterial Vaginosis (BV): This is a common condition characterized by an imbalance of the normal vaginal flora, leading to an overgrowth of bacteria. It can cause purulent discharge and is not necessarily related to sexual activity.
Other Likely Diagnoses
- Vaginal Candidiasis: A fungal infection that can cause a thick, white, cottage cheese-like discharge, but sometimes can be purulent. It's common in women and not exclusively related to sexual activity.
- Trichomoniasis: Although less likely given the absence of sexual intercourse, it's still possible if the patient has had recent sexual activity that she hasn't disclosed or if there's an alternative mode of transmission (though rare).
- Atrophic Vaginitis: This condition occurs due to the thinning and drying of the vaginal walls, often post-menopause, and can lead to a purulent discharge due to the decreased estrogen levels affecting the vaginal flora.
Do Not Miss Diagnoses
- Cervical Cancer: Although rare, cervical cancer can present with abnormal vaginal discharge. Given the potential severity, it's crucial not to miss this diagnosis, especially if there are other symptoms like abnormal vaginal bleeding.
- Pelvic Inflammatory Disease (PID): This is an infection of the female reproductive organs that can cause purulent discharge. It's often related to sexual activity but can also occur without it, especially if there's an underlying condition like an intrauterine device (IUD) placement.
- Foreign Body: The presence of a foreign body in the vagina, such as a retained tampon, can cause a purulent discharge. This condition requires immediate attention to prevent further complications.
Rare Diagnoses
- Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by a purulent discharge and inflammation of the vagina. The exact cause is unknown, but it's thought to be related to an autoimmune response or an allergic reaction.
- Vaginal Tuberculosis: Although rare in many parts of the world, vaginal tuberculosis can cause a variety of symptoms including purulent discharge. It's more likely to be considered in areas where tuberculosis is common or in patients with a history of tuberculosis.