Differential Diagnosis for Vaginal Itching and Foul Smelling Discharge
Single Most Likely Diagnosis
- Bacterial Vaginosis (BV): This condition is characterized by a thin, foul-smelling discharge and mild vaginal itching. The odor often worsens after intercourse due to the alkalinity of semen, which can react with the vaginal discharge to produce a stronger smell. A vaginal pH greater than 4.5 is a common finding in BV.
Other Likely Diagnoses
- Trichomoniasis: This sexually transmitted infection can cause vaginal itching, foul-smelling discharge, and an elevated vaginal pH. However, it is less common than BV and often presents with more severe symptoms.
- Vulvovaginal Candidiasis (VVC): Although VVC typically presents with a thick, white discharge and more intense itching, some cases can have a thinner discharge and milder symptoms. A vesicular vulvar rash may be present in VVC.
Do Not Miss Diagnoses
- Pelvic Inflammatory Disease (PID): While PID is less likely given the mild symptoms, it is crucial not to miss this diagnosis due to its potential for severe complications, including infertility and chronic pelvic pain. Cervical motion tenderness and suprapubic tenderness are common findings in PID.
- Gonorrhea or Chlamydia: These sexually transmitted infections can cause cervical motion tenderness and suprapubic tenderness. Although they may not always present with vaginal itching and discharge, they are essential to consider due to their potential for serious complications if left untreated.
Rare Diagnoses
- Desquamative Inflammatory Vaginitis (DIV): This condition is characterized by a purulent discharge and vaginal bleeding, but it can also present with itching and a foul odor. However, it is much less common than other vaginal infections.
- Vaginal Cancer: Although extremely rare, vaginal cancer can cause abnormal vaginal discharge and itching. It is essential to consider this diagnosis in postmenopausal women or those with a history of cervical cancer.