Differential Diagnosis for 70 yo Female with External Irritation and Urinary Frequency
- Single most likely diagnosis:
- Atrophic vaginitis with urinary tract infection (UTI): The patient's symptoms of external irritation, urinary frequency, and the use of topical estradiol, along with the exam findings consistent with atrophied vaginitis and the UA results showing leukocyte esterase, protein, and trace RBC, support this diagnosis. The presence of atrophied vaginitis increases the risk of UTIs due to the thinning and drying of the vaginal walls, which can lead to increased bacterial colonization.
- Other Likely diagnoses:
- Urinary tract infection (UTI) without atrophic vaginitis: Although the patient has atrophic vaginitis, a UTI can still occur independently and cause similar symptoms. The UA results support this diagnosis.
- Vaginal candidiasis: This is a common infection in postmenopausal women, especially those using topical estradiol, which can alter the vaginal pH and flora. Symptoms can include external irritation and urinary frequency.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pyelonephritis: Although less likely given the absence of nausea, abdominal pain, and negative nitrites, pyelonephritis is a serious condition that requires prompt treatment to prevent kidney damage. The presence of leukocyte esterase and protein in the UA suggests an infection that could potentially ascend to the kidneys.
- Interstitial cystitis: This condition can cause urinary frequency and external irritation. While it's less common, missing this diagnosis could lead to prolonged suffering and potential complications if left untreated.
- Rare diagnoses:
- Vaginal cancer: Although rare, especially in the absence of other symptoms like abnormal vaginal bleeding, it's essential to consider in the differential diagnosis of postmenopausal women with persistent vaginal symptoms.
- Foreign body in the urinary tract: This could cause urinary frequency and irritation, although it's less likely in this scenario without a history suggestive of a foreign body introduction.