Vulvovaginitis In Children Research Articles

Clinical and etiological characteristics of infectious vulvovaginitis in children in Zhejiang province from 2009 to 2019

Objective: To explore the clinical characteristics, common pathogens in children with vulvovaginitis. Methods: This was a retrospective cases study. A total of 3 268 children with vulvovaginitis were enrolled, who visited the Department of Pediatric and Adolescent Gynecology, Children's Hospital, Zhejiang University School of Medicine from January 2009 to December 2019. Patients were divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Patients were also divided in to 4 groups according to the season of first visit. The pathogen distribution characteristics of infective vulvovaginitis were compared between the groups. Their clinical data were collected and then analyzed by χ2 test. Results: The were 3 268 girls aged (6.2±2.5) years. There were 1 728 cases (52.9%) aged <7 years, 875 cases (26.8%) aged 7-<10 years, and 665 cases (20.3%) aged 10-18 years. Of these cases, 2 253 cases (68.9%) were bacterial vulvovaginitis, 715 cases (21.9%) were fungal vulvovaginitis and 300 cases (9.2%) were vulvovaginitis infected with other pathogens. Bacterial culture of vaginal secretions was performed in 2 287 cases, and 2 287 strains (70.0%) of pathogens were detected, of which the top 5 pathogens were Streptococcus pyogenes (745 strains, 32.6%), Haemophilus influenzae (717 strains, 31.4%), Escherichia coli (292 strains, 12.8%), Staphylococcus aureus (222 strains, 9.7%) and Klebsiella pneumoniae (67 strains, 2.9%). Regarding different age groups, H.influenzae was the most common in children under 7 years of age (40.3%, 509/1 263), S.pyogenes (41.9%, 356/849) was predominantly in children aged 7 to 10 years, and E.coli was predominant in children aged 10 to 18 years (26.3%, 46/175). Susceptibility results showed that S.pyogenes was susceptible to penicillin G (610/610, 100.0%), ceftriaxone (525/525, 100.0%), and vancomycin (610/610, 100.0%); the resistance rates to erythromycin and clindamycin were 91.9% (501/545)and 90.7% (495/546), respectively. For H.influenzae, 32.5% (161/496) produced β-elactamase, and all strains were sensitive to meropenem (489/489, 100.0%) and levofloxacin (388/388, 100.0%), while 40.5% (202/499) were resistant to ampicillin. Among E.coli, all strains were sensitive to imipenem(100%, 175/175). The resistance rates of E.coli to levofloxacin and ceftriaxone were 29.1% (43/148) and 35.1% (59/168), respectively. A total of 48 strains of methicillin-resistant Staphylococcus aureus (MRSA) were isolated with a proportion of 28.3% (45/159) in 3 268 patients. The results of drug susceptibility test showed that all MRSA strains were sensitive to linezolid 100.0% (40/40), vancomycin (45/45, 100.0%), and tigecycline (36/36, 100.0%); the resistance rates of MRSA to penicillin G, erythromycin and clindamycin were 100% (45/45), 95.6% (43/45) and 88.9% (40/45), respectively. All methicillin-sensitive Staphylococcus aureus (MSSA) strains were sensitive to oxacillin (114/114, 100.0%), linezolid (94/94, 100.0%), vancomycin (114/114, 100.0%), and tigecycline (84/84, 100.0%); it's resistance rates to penicillin G, erythromycin and clindamycin were 78.1% (89/114), 59.7% (68/114) and 46.5% (53/114), respectively. The drug resistance rate of MSSA to penicillin G, erythromycin and clindamycin were lower than those of MRSA (χ²=11.71,19.74,23.95, respectively, all P<0.001). Conclusions: The age of consultation for pediatric infectious vulvovaginitis is mainly around 6 years. The most common pathogens are S.pyogenes, H.influenzae and Escherichia coli. Third generation cephalosporins can be used as the first choice of empirical anti-infection drugs. However, the results of drug susceptibility should be considered for targeted treatment.

Clinical Symptoms and Microbiological Findings in Prepubescent Girls with Vulvovaginitis

BackgroundThe diagnosis and treatment of vulvovaginitis in children is poorly managed because it is difficult to determine whether the agent causing vulvovaginal inflammation is a single bacterial species. Study objectiveThis study retrospectively evaluated genital microbiological findings in prepubescent girls with vulvovaginitis and then compared the findings to healthy controls without discharge. MethodsThis was a retrospective case-control study of 483 prepubescent girls aged 2-10 years with vulvovaginitis and 50 age-matched healthy asymptomatic controls. Data were collected at the Pediatric General Outpatient Unit of the Hospital of the Bezmialem Vakıf University from December 2015 to March 2021. ResultsOf the 483 positive vaginal cultures in the study group, 248 (51.3%) exhibited potential causative agents. Conversely, 8 of 50 (16%) of the vaginal cultures in the control group (P < .001) exhibited potential causative agents. Streptococcus pyogenes was the most frequently detected causative agent of vulvovaginitis in the study group. S. pyogenes was present in specimens from 74 girls (15.8%) with symptoms of vulvovaginitis vs 1 (4.1%) specimen in the control group. Other specific organisms identified in the study group were Escherichia coli (12%), Haemophilus influenzae (5%), Staphylococcus aureus (4.3%), Candida albicans (4.3%), and Streptococcus agalactia (3.3%). ConclusionsAmong prepubescent girls with vulvovaginitis, 51.3% of vaginal cultures exhibited potential causative agents in the study group. Our microbiological data indicated that the most common pathogens were S. pyogenes and E. coli.

Haemophilus influenzae Vulvovaginitis in Prepubertal Girls: A 4-Year Study on a Tertiary Children’s Hospital in China

Background: Vulvovaginitis is a common infection in prepubertal girls, which is partly caused by bacterial infection. According to the literature, Haemophilus influenzae is one of the most common bacterial causes of vulvovaginitis in children. However, few studies with large sample sizes have delved into this issue. Objectives: To determine the prevalence of Haemophilus influenzae vulvovaginitis in prepubertal girls and detect the antimicrobial resistance of H. influenzae strains isolated from vulval specimens. Methods: The isolates of H. influenzae from the vulval swabs of prepubertal girls with vulvovaginitis were received from The Children’s Hospital, Zhejiang University School of Medicine, during 2016 - 2019. The vulval specimens were inoculated on Haemophilus selective chocolate agar, and antimicrobial susceptibility tests were performed by the disk diffusion method. Moreover, β-lactamase was detected using Cefinase disc. Results: In this study, 4142 vulval specimens were received during four years, of which 649 H. influenzae isolates had been isolated from 642 girls aged 6 months-13 years, with a median of 5 years. The peaks of isolates were observed from April to July in the vulval isolates. In general, the ampicillin resistance rate was 39.1% (250/640), 33.2% of strains (211/636) were β-lactamase-positive isolates, and 6.6% strains (42/635) were β-lactamase-negative ampicillin-resistant (BLNAR) isolates. The resistance rates of H. influenzae isolates to amoxycillin-clavulanic acid, ampicillin-sulbactam, cefuroxime, ceftriaxone, cefotaxime, meropenem, levofloxacin, sulfamethoxazole-trimethoprim, azithromycin, and chloramphenicol were 26.4%, 21.8%, 24.8%, 1.7%, 1.0%, 0.2%, 0%, 47.7%, 10.2%, and 1.1%, respectively. Multi-drug resistance (MDR) was noticed in 41 persons (6.4%) out of the 642 H. influenzae isolates, with the most prevalent MDR phenotype of ampicillin-sulfamethoxazole-trimethoprim-azithromycin resistance. Conclusions: Clinicians should noticed that H. influenzae is a common bacterial cause of vulvovaginitis in children, and laboratories should routinely cover Haemophilus culture media for vulval specimens. The ampicillin resistance of H. influenzae should also be considered in clinical management.

Vulvo-vaginitis in Prepubertal Girls: New Ways of Administering Old Drugs

Study ObjectiveTo evaluate the effectiveness and safety of local vs systemic antibiotic treatment in the management of recurrent vulvovaginitis in children. DesignRandomized treatment and follow-up of 90 cases of persistent vulvovaginitis. SettingThe Department of Medicine and Health Sciences, Institute of Gynecology and Obstetrics, University of Molise, Italy. MethodsBetween January 2009 and December 2012, 90 prepubertal girls (Tanner Stage I) aged 6–12 years, with recurrent discharge not responding to common hygienic measures and not suspected of being sexually abused, were treated, 45 patients with oral antibiotic treatment (group 1) and 45 patients with a local antibiotic treatment (group 2). Vaginal cultures were prepared before treatment and follow-ups were made after 3 months. ResultsBacterial pathogens were isolated in vaginal secretions of 84/90 (93%) girls. There were 6 girls receiving antibiotic treatment who had persistent discharge and repetitive isolations of Escherichia coli. Administration type was selected at random. Symptoms and signs were resolved in all girls, but we observed 1 recurrence (2.22%) in group 2 vs 6 recurrences (13.33%) in group 1 (P = .049). In group 1 we observed 3 cases (6.67%) of gastro-intestinal side effects vs no cases in group 2 (P = .079). ConclusionTopical medication based on netilmicin, associated with Benzalkonium-Chloride, showed a clinical and microbiological effectiveness in first-line treatment of bacterial vulvovaginitis in children, comparable to conventional drugs; so local treatment may be a good alternative to systemic treatment decreasing the use of oral antibiotics in young people and related risks of bacterial resistances.

VulVoVaginitis in children and teens: releVance of clinical diagnosis

VulVoVaginitis in children and teens: releVance of clinical diagnosis

Association between group A beta-haemolytic streptococci and vulvovaginitis in adult women: a case–control study

Guidelines for the management of vaginal discharge mention Candida albicans, Trichomonas vaginalis, bacterial vaginosis, Chlamydia trachomatis and Neisseria gonorrhoeae as causes and do not recommend full microbiological culture. The role of non-group B beta-haemolytic streptococci in vaginal cultures is unclear, except for group A streptococci that are known to cause vulvovaginitis in children. In a case-control study, we investigated the association between non-group B beta-haemolytic streptococci and vulvovaginitis in adult women. Cases were women with recurrent vaginal discharge from whom a sample was cultured. Controls were asymptomatic women who consented to submitting a vaginal swab. Group A streptococci were isolated from 49 (4.9%) of 1,010 cases and not from the 206 controls (P < 0.01). Isolation rates of group C, F and G streptococci were low and did not differ statistically between cases and controls. Group A beta-haemolytic streptococci are associated with vaginal discharge in adult women. The other non-group B streptococci require more study. For the adequate management of vaginal discharge, culturing is necessary if initial treatment fails. Guidelines should be amended according to these results.

Gastrointestinal: Enterobiasis

Gastroenterologists who perform colonoscopy are likely to encounter occasional patients with small worms in the large bowel. The most common worm is Enterobius vermicularis (pinworm or threadworm). The infestation is acquired by direct person-to-person transmission, by autoinfection or by indirect spread associated with the handling of bed linen. Larvae in ingested eggs hatch in the jejunum, develop in the ileum and finally reside in the cecum and other parts of the colon. The female worm is 8–13 mm long while the male worm is only 2–5 mm long. The average lifespan of the worms is approximately 50 days. The only definite symptom attributed to enterobiasis is that of anal pruritis. This occurs when female worms actively pass out of the anus at night and lay sticky eggs over the perianal skin. Other clinical syndromes associated with enterobiasis may include vulvovaginitis in children and perhaps acute appendicitis. Enterobiasis is endemic throughout the world and particularly affects pre-school children, children in primary schools and children in institutions. Infestation rates may also increase in advanced age. Pinworms do not appear to cause inflammation in the large bowel and have not been associated with increases in blood eosinophils or serum IgE. The diagnosis can be made by the identification of worms at sigmoidoscopy or colonoscopy. However, the usual diagnostic test is the identification of eggs on a tape that is applied to the perianal area first thing in the morning. Several drugs are effective including mebendazole, albendazole and pyrantel pamoate. The patient illustrated below was a 90-year-old man who was admitted to hospital with abdominal pain and abdominal distension. Additional medical problems included hypertension, paroxysmal atrial fibrillation and chronic obstructive pulmonary disease. Blood tests revealed a mild normocytic anemia with a marked elevation of the erythrocyte sedimentation rate (108 mm/hr). A plain abdominal x-ray showed fecal loading in the colon. At colonoscopy, the only abnormality was thousands of small pinworms throughout the large bowel (Figure 1). Pinworms close to the anal canal are shown by retroflexion of the colonoscope in Figure 2. The appearance was typical of heavy infestation. His symptoms appeared to improve after treatment with albendazole.

Vulvovaginitis

Vulvovaginitis

A spirochete-like bacteria observed in Gram-stained vaginal smears.

Sin resumen

Pinworms in pregnancy.

The intestinal parasite that family physicians are most likely to see in the office is the pinworm, Enterobius vermicularis. 1 Prevalence in the United States is estimated to be 20 to 42 million cases, with the greatest rate of infestation in children between the ages of 5 and 14 years. I Parents and other siblings will likely be infected if one child in the family becomes infected. Pinworms commonly spread from the contaminated hands of infected children (60 percent of infested children have Enterobius embryos under their fingernails).2 Pinworms can also spread from infested bedclothes, bedding, dust, food, and eating utensils. Prevalence of pinworm infestation remains high in spite of greater knowledge of the parasite and its relation to humans. Enterobius vermicularis is a parasite that usually lives in the human gastrointestinal tract. The female worm migrates to the anus or rectum at night to lay eggs. The eggs can disperse ~ro~gh­ out the general surroundings and remaIn vIable in the intestinal tract for up to 20 days.3 The larvae develop within a few hours in the ova, th~n migrate to the large bowel, where they mature In 15 to 28 days.4 Involvement of the genital tract is less common, but cases have been reported in the medicalliterature.5,6 Pregnant worms often migrate to the patient's anus to lay eggs at night, but they can enter the vagina a~d travel ~e len~.of the genital tract to the pentoneum. The abIlIty of the parasite to migrate to several areas of ~e body and through various organ systems led HIPpocrates to call it the "hopper."2 Cases of vulvovaginitis in children and women have been :eported. Ova have been discovered on routme Papanicolaou smears, and a case was reported with pinworm infestation of a st~llborn.8-~o ~o reports of pinworms causing cervIcal bleedIng In pregnancy, however, were found in a search of the current medical literature.

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.

Vulvovaginitis and Other Local Lesions of the Vulva

Vulvovaginitis is the most common gynaecological lesion seen in children, both in hospital clinic practice and in private office practice. The causes for this are multiple and one should seek the aetiology before therapy is instituted. The complete diagnostic workup done on some of the patients is outlined. However, we find the practical approach to vulvovaginitis in children which begins with simpler procedures and reserves the more complicated and expensive diagnostic procedure for later to be worthwhile. This works nicely in office practice in our hands.

The treatment of gonococcal vulvovaginitis inchildren: A report of 18 cases treated by the implantation ofestradiol benzoate

Eighteen cases of gonococcal vulvovaginitis in children were treated with estradiol benzoate by implanting a pellet representing 90,000 International units in the fat of the buttock. Within an average of 8.3 days after the implantation squamous epithelial cells began to appear. Within an average of 13.6 days after the implantation all cases showed squamous epithelial cells and negative smears for the gonococcus. No recurrences of the infection have occurred to date. One patient had slight vaginal bleeding on two occasions. Four othersshowed moderate breast enlargement, and one of these developed a few pubic hairs. Eighteen cases of gonococcal vulvovaginitis in children were treated with estradiol benzoate by implanting a pellet representing 90,000 International units in the fat of the buttock. Within an average of 8.3 days after the implantation squamous epithelial cells began to appear. Within an average of 13.6 days after the implantation all cases showed squamous epithelial cells and negative smears for the gonococcus. No recurrences of the infection have occurred to date. One patient had slight vaginal bleeding on two occasions. Four othersshowed moderate breast enlargement, and one of these developed a few pubic hairs.

The treatment of gonorrheal vulvovaginitis inchildren with silver picrate suppositories

The treatment of gonorrheal vulvovaginitis inchildren with silver picrate suppositories

The Clinical and Administrative Aspects of Vulvo-Vaginitis in Children

The Clinical and Administrative Aspects of Vulvo-Vaginitis in Children

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

SULFANILAMIDE IN THE TREATMENT OF GONORRHEAL VULVOVAGINITIS

Gonorrheal vulvovaginitis in children is a common disease; at the Cook County Hospital alone we treat about 150 patients a year. Brunet and his co-workers 1 estimate that it occurs in from 1 to 5 per cent of the female children of the poor sections of the larger cities. We feel that this estimate is very conservative. In 1930 we were called to an institution to take care of several patients with vaginitis. After taking smears of all the girls, approximately 300, we found that 20 per cent were positive for gonococci. In Chicago there is a high percentage of active cases among the Negro population. The sources of infection are numerous. In institutions the diaper appears to be the chief source of infection. Towels, linen, thermometers, bath tubs, attendants and nurses also may convey the organism from one child to another. About 80 per cent of our patients are

VULVO-VAGINITIS IN CHILDREN

The Author reports 45 cases of vulvovaginitis in children. In agreement with the literature the reported data show a fairly high prevalence of concomitant urinary infections. Timely and correct treatment of genital and urinary inflammations can prevent relapses, new infections and reduce the incidence of more serious urinary phlogosis to a minimum.

Torsion of undiseased uterine adnexa in virgins

The purpose of this paper is to consider the twisting of oviducts and ovaries which are otherwise normal without other coexisting pelvic pathology. In order to eliminate all reasonable possibility of inflammation it is deemed advisable not to include those cases in which the condition has occurred beyond the age of sixteen years. It must be realized that coitus introduces the possibility of pelvic infection, and there is no assurance of virginity beyond this age. Perhaps we should have limited our consideration of cases to those who had not reached puberty, because occasionally the state of virginity is terminated soon after. On the maternity services of two Detroit hospitals 94 girls sixteen years of age or under were delivered in one year (1929) and one of the patients was only eleven years old. During this same period of time (one year) the records of the Juvenile Court of Detroit show that of the 1886 girls sixteen years of age or under examined, only 566 or 30 per cent had intact hymens. Schied1 in 1922 reported having operated upon a fifteen-year-old patient with pyosalpingitis and another, thirteen years old, with chronic active salpingitis. Gonorrheal vulvovaginitis in children and young girls is a common disease. Married women could not be considered, even if there were not the element of pregnancy, because the assurance of normal oviducts in this group is still more remote.

DR. IRVING F. STEIN'S REPLY TO THE COMMENT OF DR. SCHAUFFLER

To the Editor: —In reply to the recent communication of Dr. Schauffler, I wish to thank the doctor for his interest and his kindly criticism. In regard to the ointment, I have used hydrous wool fat, mixed with petrolatum and 1 per cent mercurochrome-220, ever since we first began our work on vulvovaginitis in 1921. Hydrous wool fat, according to Cushney (edition 4, p. 50), miscible in twice its weight of water without losing its ointment consistency, and therefore is capable of absorbing the vaginal moisture completely. I have not materially changed our technic of treatment in the past seven years except for the additional use of the vaginoscope in the study of our patients. Will you kindly refer Dr. Schauffler to our former publications (A Clinical Investigation of Vulvovaginitis, Surg. Gynec. Obst. 36 :43 [Jan.] 1923; A Bacteriologic Study of Vulvovaginitis in Children, J. Infect. Dis., 32 :444