Differential Diagnosis for Vaginal Itching and Discharge
- Single most likely diagnosis
- Vulvovaginal candidiasis: This is the most likely diagnosis given the patient's symptoms of vaginal itching, discharge, and pain with sexual intercourse, combined with the physical examination findings of vulvar and vaginal erythema and a vaginal discharge pH of 4. The patient's use of oral contraceptive pills, which can alter the vaginal flora, and the absence of systemic symptoms such as fever or abdominal pain, further support this diagnosis.
- Other Likely diagnoses
- Bacterial vaginosis: Although the discharge pH is 4, which is within the normal range, bacterial vaginosis is still a consideration due to the presence of vaginal discharge and the patient's history of new sexual partners. However, the lack of a fishy odor and the normal pH make this less likely.
- Trichomoniasis: This sexually transmitted infection can cause vaginal itching, discharge, and pain with intercourse. The patient's history of new sexual partners increases the likelihood of this diagnosis, but the absence of a greenish, frothy discharge and the normal pH make it less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pelvic inflammatory disease (PID): Although the patient does not have systemic symptoms such as fever or abdominal pain, PID is a critical diagnosis to consider due to its potential for severe complications, including infertility and chronic pelvic pain. The patient's history of new sexual partners increases her risk for PID.
- Gonorrhea or chlamydia: These sexually transmitted infections can cause vaginal discharge and pain with intercourse. While the patient's symptoms are not typical for these infections, her history of new sexual partners necessitates consideration of these diagnoses to prevent long-term complications.
- Rare diagnoses
- Desquamative inflammatory vaginitis: This rare condition can cause vaginal itching, burning, and discharge. However, it is less common and typically presents with a purulent discharge, which is not described in this patient.
- Vaginal malignancy: Although extremely rare in a 32-year-old woman, vaginal cancer can cause abnormal vaginal bleeding or discharge. This diagnosis would be considered if the patient's symptoms persist despite treatment for more common conditions.