Differential Diagnosis for Clear Vaginal Discharge
- Single Most Likely Diagnosis
- Physiologic leukorrhea: This is the most likely diagnosis given the clear nature of the discharge, the absence of odor or irregular bleeding, and the patient's recent discontinuation of oral contraceptives. The presence of clear mucus at the cervical os further supports this diagnosis, as it is consistent with the normal increase in cervical mucus production during the follicular phase of the menstrual cycle.
- Other Likely Diagnoses
- Yeast infection (candidiasis): Although the discharge is described as clear, a yeast infection could still be considered, especially if the patient has recently stopped using oral contraceptives, which can alter the vaginal flora. However, the absence of itching, burning, or odor makes this less likely.
- Bacterial vaginosis (BV): BV typically presents with a malodorous, thin discharge. However, in some cases, the discharge may be clear, and the absence of odor does not entirely rule out BV, especially if the patient has recently changed her contraceptive method.
- Cervicitis: This could be considered if there were symptoms such as post-coital bleeding or pelvic pain, but the patient's presentation does not strongly suggest cervicitis.
- Do Not Miss Diagnoses
- Pelvic inflammatory disease (PID): Although the patient does not have symptoms such as pelvic pain or fever, PID is a critical diagnosis not to miss due to its potential for long-term consequences, including infertility. The absence of adnexal masses on bimanual examination does not rule out PID entirely.
- Ectopic pregnancy: Given the patient's desire to conceive and the recent discontinuation of oral contraceptives, ectopic pregnancy must be considered, especially if there were any missed periods or irregular bleeding, despite the patient's last menstrual period being 10 days ago.
- Rare Diagnoses
- Cervical cancer: This would be extremely rare in a 28-year-old woman without risk factors, but any abnormal vaginal bleeding or discharge warrants consideration of cervical cancer, especially if the patient has not had regular Pap smears.
- Foreign body: The presence of a foreign body in the vagina could cause an increase in discharge, but this would typically be associated with other symptoms such as odor or bleeding, and the patient's history does not suggest this.