Question

A woman, anxious to conceive, complains of profuse white discharge per vaginum, which was non foul smelling and not itchy. Her LMP was 13-15 days back. What is the most probable diagnosis?

• A. Candidiasis
• B. Bacterial Vaginosis
• C. Physiological
• D. Trichomoniasis

Hint:

Consider the timing relative to the menstrual cycle when evaluating vaginal discharge.

Answer 1

The Correct Option is C

Step 1: Analyze the clinical features.
The patient presents with:
- Profuse white vaginal discharge
- Non-foul smelling
- Not itchy
- LMP was 13-15 days back (i.e., she is around mid-cycle / ovulatory phase)
- She is anxious to conceive (relevant context)

Step 2: Apply knowledge of physiological vaginal discharge.
Physiological leucorrhoea occurs at mid-cycle (around day 14) due to rising estrogen levels. At ovulation, the cervical mucus becomes copious, clear, stretchy (like raw egg white -- Spinnbarkeit), and non-offensive. The amount of discharge at ovulation can be up to 30 times greater than during the follicular phase. This is normal and not a sign of infection.

Step 3: Differentiate from pathological causes.
- Candidiasis: causes thick, curdy (cottage-cheese-like) white discharge with marked itching and vulval erythema.
- Bacterial vaginosis: causes greyish-white, foul-smelling (fishy odour) discharge, but not itchy.
- Trichomoniasis: causes frothy, yellow-green, foul-smelling discharge with itching and dysuria.

Step 4: Conclusion.
The absence of itching, absence of foul odour, and the timing at 13-15 days post-LMP all point to physiological discharge around ovulation.