Differential Diagnosis for Vaginal Discharge
- Single most likely diagnosis
- Bacterial vaginosis (BV): This is the most likely diagnosis given the patient's symptoms of malodorous vaginal discharge, which is characteristic of BV. The absence of vulvar or vaginal erythema, lesions, or cervical discharge also supports this diagnosis.
- Other Likely diagnoses
- Vulvovaginal candidiasis: Although less likely than BV due to the lack of described itching or burning, candidiasis can cause an off-white discharge and is a common condition in sexually active women.
- Trichomoniasis: This sexually transmitted infection can cause a malodorous discharge, although it often presents with other symptoms such as itching, burning, or postcoital spotting, which are not mentioned in the patient's history.
- 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 the typical symptoms of PID such as pelvic pain or fever, and the physical examination does not reveal uterine or adnexal tenderness, PID is a critical diagnosis not to miss due to its potential for severe complications, including infertility and ectopic pregnancy. The patient's history of chlamydial cervicitis and new sexual partner increase her risk.
- Cervical cancer: While extremely unlikely in a 25-year-old woman without risk factors such as HPV infection or abnormal Pap smears, any abnormal vaginal bleeding or discharge could potentially be a symptom of cervical cancer, making it a diagnosis that should not be entirely ruled out without further evaluation.
- Rare diagnoses
- Desquamative inflammatory vaginitis (DIV): A rare condition characterized by a purulent vaginal discharge, which could be considered if other more common causes are ruled out.
- Foreign body: The presence of a foreign body in the vagina, such as a retained tampon, can cause a malodorous discharge. However, this would be unusual in a patient without a history suggestive of such an issue.