Vaginitis In Children Research Articles

Vaginitis

Vulvovaginal complaints are a common indication for women to seek gynecologic care. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, which account for 22 to 50%, 17 to 39%, and 4 to 35% of vaginitis, respectively. This review describes the presentation, diagnosis, and prevention strategies for the most important causes of vulvovaginitis, including characteristic findings on office microscopy and newer available diagnostic testing. It outlines treatment modalities for uncomplicated infections in healthy women, as well as nuances of treatment for recurrent and persistent infections, pregnant women, and HIV-positive women. It also explores the diagnosis and management of non-infectious vaginitis as well special consideration for vaginitis in children and adolescents. This review contains 4 figures, 11 tables, and 58 references. Key words: vaginitis, vulvovaginitis, bacterial vaginosis, candidiasis, trichomoniasis, vaginitis treatment

Vaginitis

Vulvovaginal complaints are a common indication for women to seek gynecologic care. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, which account for 22 to 50%, 17 to 39%, and 4 to 35% of vaginitis, respectively. This review describes the presentation, diagnosis, and prevention strategies for the most important causes of vulvovaginitis, including characteristic findings on office microscopy and newer available diagnostic testing. It outlines treatment modalities for uncomplicated infections in healthy women, as well as nuances of treatment for recurrent and persistent infections, pregnant women, and HIV-positive women. It also explores the diagnosis and management of non-infectious vaginitis as well special consideration for vaginitis in children and adolescents. This review contains 4 figures, 8 tables, and 55 references. Key words: vaginitis, vulvovaginitis, bacterial vaginosis, candidiasis, trichomoniasis, vaginitis treatment

Vaginitis. Ampliando el espectro diagnóstico

El diagnóstico de vaginitis usualmente se asocia a vaginosis bacteriana, Trichomonas vaginalis o Cándida albicans. Sin embargo, no son los únicos responsables de flujo vaginal, el síntoma más frecuente de vaginitis. En esta comunicación se presenta otras causas menos frecuente de flujo vaginal. Los casos de vaginitis en la niña son generalmente secundarios a problemas dermatológicos en la vulva. La presencia de flujo sanguinolento con mal olor puede ser por un cuerpo extraño en la vagina. Las bacterias que producen vaginitis con más frecuencia en las niñas son Hemophylus influenzae, estreptococo grupo A y Escherichia coli. El tratamiento debe ser dirigido a la causa del problema. En la mujer pre y posmenopáusica, la presencia de flujo puede ser por vaginitis atrófica o vaginitis inflamatoria descamativa. Con relación al tratamiento, en el primer caso se recomienda el uso de estrógenos tópicos o sistémicos y en el segundo el uso de clindamicina al 2% en crema vaginal. Una causa de flujo puede ser la cervicitis, siendo los agentes patógenos más frecuentes en esta localización el Chlamydia trachomatis y el Neisseria gonorrhoeae. El tratamiento recomendado en estos casos sería azitromicina o doxicilina y ceftriaxona o ciprofloxacino, respectivamente.

Foreign Body in Vagina: An Uncommon Cause of Vaginitis in Children

Vaginal discharge in children may result from a variety of causes. A long-standing intra-vaginal foreign body can pose both diagnostic and therapeutic challenges in children. Treatment failure may occur because of alteration of the normal vaginal flora. A 6-year-old girl, who lived with her parents, presented with a foul-smelling, blood-stained vaginal discharge as well as dysuria for 2 years. There was no history of sexual abuse. Initial evaluation that excluded gynecologic examination revealed lower abdominal tenderness. Vaginal swab and urine cultures yielded Staphylococcus aureus sensitive to ceftriaxone only. She was commenced on this antibiotic for 2 weeks, but the discharge persisted, necessitating referral to the gynecologist. Examination under anesthesia by the gynecologist revealed shreds of toilet tissue paper extracted from the vagina and slight excoriations on the wall of the vagina. Vaginal foreign body can present with diverse symptoms. It should be considered in any young female patient presenting with recurrent or persistent vaginal discharge.

Adenocarcinoma de Células Claras de Endocérvice em Menina de 7 anos

O adenocarcinoma de células claras de colo e vagina em adolescentes é uma doença rara e na maioria das vezes associada com o uso do dietilestilbestrol (DES) durante a gestação. A queixa mais freqüente é o sangramento vaginal irregular que pode ser incorretamente interpretado como vaginite nas crianças e como alterações do eixo hipotálamo-hipófise nas adolescentes. Relatamos o caso de adenocarcinoma de células claras de endocérvice em uma menina de 7 anos de idade atendida no Ambulatório de Ginecologia da Infância e Adolescência, e chamamos a atenção para o diagnóstico de câncer genital que, embora raro nesta faixa etária, deve ser cogitado quando deparamos com sangramento genital em crianças.

Group A streptococcal vaginitis in children.

Group A streptococcal vaginitis in children.

Chronic Vulvovaginitis in Children Due to Shigella flexneri

Although previous reports have implicated Shigella flexneri in resistant or chronic cases of vulvovaginitis in children, no authors have described the clinical findings of this condition. The report presents four cases of persistent vulvovaginitis in prepubertal Indian girls from different reservation communities in Arizona. S. flexneri was isolated in pure culture from the vaginal discharge of each patient. All four cases were characterized by a prolonged vaginitis with a bloody, purulent discharge which responded poorly or not at all to various topical modes of therapy for nonspecific vaginitis. Three cases cleared completely when treated with orally given ampicillin for one week. The striking similarity of these cases suggests that chronic Shigella vulvovaginitis is a recognizable clinical entity and should be considered in the differential diagnosis of persistent vaginitis in children, especially in those from communities where Shigella is endemic.

Experiences in a vaginitis clinic. Summarizing experiences gained from 14 to 20 weekly visits -- mostly by patients in childbearing years.

A clinic devoted mainly to the diagnosis and treatment of vaginal infections dealt with more than 6,000 patients (12,500 patient-visits) in a period of 13 years. An exact initial diagnosis was found necessary in choosing specific therapy, and included cultures for trichomonads, fungi, and bacteria. At subsequent visits, both clinical and microbiologic reappraisals were necessary in order to tell whether therapy needed to be prolonged or changed. The management of vaginitis in children was based on the same principles as in adults, and treatment was undertaken only after complete pelvic investigation.

Vaginitis in children.

Prior to the penicillin era most of the reports of vaginitis in children were concerned with the management of gonorrheal vaginitis. 1-3 Since then, gonorrhea has practically disappeared and nonspecific bacterial vaginitis has assumed primary importance. In this preantibiotic period, estrogen was used widely in the treatment of vaginitis in children. The work of Robert Lewis, 1 in 1933, pioneered this therapeutic approach. Lewis and others 2,4 felt that vaginitis in children was due to an exaggeration of the normal hypoestrogenism of childhood, which in turn produced an atrophy of the vaginal mucosa. Estrogen administration could increase the cellular depth of the vaginal epithelial layer, and this artificially hypertrophied surface acted as a barrier to the invasion of bacteria. Gonorrheal vaginitis was treated therefore with local or systemic estrogens. In the current reports of preadolescent vaginitis, most authors stress the importance of general health measures, the presence of other infections

The iodine vapor stained vaginal smear; its use in office practice.

ATTENTION was drawn to the usefulness of the human vaginal smear in the clinical investigation of endocrine problems by Papanicolaou (1) in 1933. He described the cyclic changes that may be observed in the vaginal smear during the normal menstrual cycle. In a later paper (2) he reported the atrophic changes in the vaginal smears of menopausal patients and the reversal of these changes under estrogen therapy. Subsequently, various other investigators have used the vaginal smear to evaluate the effect of therapy in the menopause (3, 4), in amenorrhea (5), and in gonorrheal vaginitis in children (6); to assay and compare various estrogenic preparations and the methods of administering them (7, 8, 9); to attempt to detect ovulation (10, 11), and as a diagnostic and prognostic aid in abortion (12, 13). In view of the complexity of the staining technic described by Papanicolaou, a number of modifications and other stains have been introduced. One of the simplest and easiest to interpret is the iodine vapor stai...

GONOCOCCIC VAGINITIS IN CHILDREN TREATED WITH A SINGLE INJECTION OF PENICILLIN IN BEESWAX AND PEANUT OIL

PENICILLIN given as a single injection in the beeswax and peanut oil mixture developed by Romansky¹has been reported²to be from 80 to 100 per cent effective in the treatment of gonorrhea in adults. The present study was undertaken because to our knowledge the effectiveness of this method of administration of penicillin in a group of cases of vaginitis in children has not been reported. <h3>MATERIAL</h3> The patients were 20 Negro girls, ranging from 2 to 10 years of age, with uncomplicated, previously untreated gonococcic vaginitis (table). They were treated by the staff of the Chicago Municipal Social Hygiene Clinic between April 1945 and June 1946. Purulent or mucopurulent vulvovaginal exudate was present in each patient with local inflammatory signs of varying degree, often mild. At least one smear of the vaginal secretion showed typical gram-negative intracellular diplococci before treatment, which was not withheld pending report of

One-dose penicillin treatment of chronic gonorrheal vaginitis in children: Sako, Wallace, Tillbury, Ross, and Colley, Jesse: J. A. M. A. 128: 508, 1945

One-dose penicillin treatment of chronic gonorrheal vaginitis in children: Sako, Wallace, Tillbury, Ross, and Colley, Jesse: J. A. M. A. 128: 508, 1945

The treatment of gonococcal vaginitis in children with diethylstilbestrol: Woodruff, J. D., and TeLinde, R. W.: South. M. J. 35: 389, 1942

The treatment of gonococcal vaginitis in children with diethylstilbestrol: Woodruff, J. D., and TeLinde, R. W.: South. M. J. 35: 389, 1942

Newer aspects in the treatment of vaginitis in children

Newer aspects in the treatment of vaginitis in children

GONORRHEAL VAGINITIS IN CHILDREN

A previous review (Benson and Steer, 1937) of the literature on gonorrheal vaginitis in children covered the more important contributions up to 1936. Reviews of the literature have also been published by Thomas and by Reichert and his associates. Since the time of those reviews there has been widespread interest in gonorrheal vaginitis, and new methods of diagnosis and treatment have resulted. Recent publications on the normal anatomy of the genital tract and the pathologic anatomy of gonorrheal vaginitis have produced valuable information. Because of these new contributions it has seemed worth while to bring the review up to date. INCIDENCE The previous survey indicated that gonorrheal vaginitis in children was of frequent occurrence. Since the time of its publication the following authors have supported that contention: Rice, 1,200 cases in hospitals, clinics and child-caring institutions of New York in 1936; Rosenthal and Weinstein, 343 reported cases in New York

CANCER OF THE BREAST POSSIBLY INDUCED BY ESTROGENIC SUBSTANCE

Estrogenic substances are now administered by physicians in a wide variety of physiologic and pathologic states. They are given to relieve menopausal symptoms, to suppress lactation, for gonorrheal vaginitis in children and for senile vaginitis and pruritus vulvae. They have been advocated for amenorrhea, abnormal uterine bleeding, dysmenorrhea, sterility, habitual abortion, chronic mastitis, painful breasts, hypertension, involutional melancholia, epilepsy, eclampsia, vomiting of pregnancy, menopausal arthritis, migraine, hemophilia, senile deafness, atrophic rhinitis and acne. New and more potent preparations of the estrogens are being made available to the medical profession for these therapeutic uses. In addition, the public has been purchasing in drug stores and beauty shops a face cream which contains estradiol. Moore 1 has shown that this hormone is absorbed through the skin. This widespread use of the estrogenic substances is, in the light of our knowledge of their possible carcinogenic effect, a matter for serious consideration. It is

Gonorrheal Vaginitis in Children

Gonorrheal Vaginitis in Children

TREATMENT OF GONOCOCCIC INFECTIONS IN CHILDREN WITH SULFANILAMIDE

On the suggestion that the gonococcus was one of the organisms susceptible to sulfanilamide, it was decided to treat gonorrheal vaginitis in children by oral administration of sulfanilamide in further search for a simple and effective method of handling this therapeutic problem. After encouraging results had been obtained in cases of vaginitis, sulfanilamide was applied to the treatment of gonorrheal urethritis in boys and of gonorrheal conjunctivitis. This report summarizes the results of treatment with sulfanilamide in 9 cases of conjunctivitis, in 5 cases of urethritis in boys and in 22 cases of vaginitis in girls since May 1937. Diagnosis of gonococcic infection was made on the basis of the finding of gram-negative intracellular diplococci, morphologically typical of gonococci, in smears from the eyes, urethra or vagina. Gonococcic complement fixation tests made on admission were positive in about two thirds of the patients. Cultures for gonococci were not available to

Treatment of gonorrheal vulvo vaginitis in children with follicular hormone: Di Paola, G.: Bol. Soc. Obst. y ginec. de Buenos Aires16: 242, 1937

Treatment of gonorrheal vulvo vaginitis in children with follicular hormone: Di Paola, G.: Bol. Soc. Obst. y ginec. de Buenos Aires16: 242, 1937

Gonorrheal vaginitis in children: Lewis, R. M., and Adler, E. L.: Am. J. Surg.33: 529, 1936

Gonorrheal vaginitis in children: Lewis, R. M., and Adler, E. L.: Am. J. Surg.33: 529, 1936