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, also supports this diagnosis.
- Other Likely diagnoses
- Bacterial vaginosis: Although the discharge pH is 4, which is within the normal range, bacterial vaginosis is still a possibility, especially given the patient's symptoms of vaginal discharge and itching. However, the presence of vulvar and vaginal erythema is less typical for bacterial vaginosis.
- Trichomoniasis: This sexually transmitted infection can cause vaginal itching, discharge, and pain with sexual intercourse, making it a plausible diagnosis, especially given the patient's history of new sexual partners.
- Chlamydia or gonorrhea: While these infections can cause cervical discharge and pelvic pain, they are less likely to cause the symptoms of vaginal itching and discharge described in this case. However, the patient's history of new sexual partners increases the likelihood of these infections.
- 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 symptoms such as fever, abdominal pain, or urinary frequency, PID is a serious condition that can have significant long-term consequences if not treated promptly. The patient's history of new sexual partners and the presence of vaginal discharge increase the risk of PID.
- Cervical cancer: While unlikely in a 32-year-old woman, cervical cancer can cause abnormal vaginal bleeding or discharge. A Pap smear should be considered as part of the diagnostic workup.
- Rare diagnoses
- Desquamative inflammatory vaginitis: This rare condition can cause vaginal itching, burning, and discharge, but it is less common than other causes of vaginitis.
- Allergic contact dermatitis: This condition can cause vulvar and vaginal itching and erythema, but it is less likely given the patient's symptoms of vaginal discharge and pain with sexual intercourse.
- Lichen planus or lichen sclerosus: These rare dermatological conditions can cause vulvar itching and pain, but they are less likely given the patient's symptoms of vaginal discharge.