Candida vulvovaginitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2], Aravind Kuchkuntla, M.B.B.S[3]

Overview

Candida Vulvovaginitis must be differentiated from diseases with similar presentation such as bacterial vaginosis, trichomonas vaginitis and atrophic vaginitis.

Differentiating Candida Vulvovaginitis from other Diseases

Candida Vulvovaginitis must be differentiated from the following diseases which have a similar presentation:

Disease	Findings
Trichomoniasis	Presents with purulent, malodorous, thin discharge associated with burning, pruritus, and dysuria, with the signs of vaginal inflammation and elevated vaginal pH (>4.5) Motile trichomonads on wet mount are demonstrated Positive culture (Gold standard) Positive nucleic acid amplification test (NAAT)
Atrophic vaginitis	Progressive symptoms Presents with yellow and malodorous vaginal discharge, vaginal dryness, postcoital bleeding, and dyspareunia with the signs of vaginal inflammation and elevated vaginal pH (>5) Diagnosis is critical and laboratory tests help to confirm hypoestrogenic state
Desquamative inflammatory vaginitis	Chronic clinical syndrome with unknown etiology Presents with dyspareunia, dyspareunia, yellow, grey, or green profuse vaginal discharge with the signs of vaginal inflammation and elevated vaginal pH (>4.5) Microscopy shows large number of parabasal (immature squamous epithelial cells) and inflammatory cells
Bacterial Vaginosis	Presents with dysuria, vaginal discharge Fishy odor (positive whiff test) Normal vaginal PH (<4.5) On speculum examination signs of vaginal inflammation are demonstrated.