Differential Diagnosis for Vaginal Irritation
Single most likely diagnosis
- Bacterial Vaginosis (BV): The patient's swab test is positive for BV, which is a common cause of vaginal irritation, discharge, and odor. The symptoms and test result align with this diagnosis.
Other Likely diagnoses
- Vulvovaginal Candidiasis (VVC): Also known as a yeast infection, VVC can cause vaginal irritation, itching, and discharge. It's a common condition that can occur alongside or instead of BV.
- Trichomoniasis: A sexually transmitted infection that can cause vaginal irritation, discharge, and odor. Although the swab is positive for BV, it's possible for multiple infections to coexist.
- Atrophic Vaginitis: A condition caused by decreased estrogen levels, leading to vaginal dryness, irritation, and discomfort. It's more common in postmenopausal women but can occur in perimenopausal women as well.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cervical Cancer: Although rare, cervical cancer can cause vaginal irritation and discharge. It's essential to rule out this possibility, especially if the patient has a history of abnormal Pap smears or is overdue for screening.
- Pelvic Inflammatory Disease (PID): A serious infection that can cause vaginal irritation, pelvic pain, and fever. If left untreated, PID can lead to severe complications, including infertility and chronic pain.
- Toxic Shock Syndrome (TSS): A rare but life-threatening condition that can cause vaginal irritation, fever, and rash. It's often associated with tampon use, but other factors can contribute to its development.
Rare diagnoses
- Desquamative Inflammatory Vaginitis (DIV): A rare condition characterized by vaginal inflammation, discharge, and pain. It's often misdiagnosed as other conditions, and its exact cause is unknown.
- Lichen Planus: A chronic autoimmune condition that can affect the vagina, causing irritation, itching, and discharge. It's rare and often requires a biopsy for diagnosis.
- Lichen Sclerosus: A rare condition that causes thinning and patchy skin lesions on the vulva, leading to vaginal irritation and discomfort. It's often associated with autoimmune disorders.