Vulvovaginitis In Prepubertal Girls Research Articles

Microbiological Findings of Symptomatic Vulvovaginitis in Chinese Prepubertal Girls.

To study the bacteria and fungi causing vulvovaginitis in prepubertal girls. Swabs from vaginal introitus were collected from patients with vulvovaginitis in 2018, and cultured for the identification of microorganisms with standard microbiological techniques. A children's hospital in Hangzhou, East China. A total of 1235 Chinese prepubertal girls diagnosed with vulvovaginitis. Bacteria or fungi in pure cultures or as the predominant organism were defined as pathogens. A total of 1235 cases were diagnosed as vulvovaginitis, and 515 isolates were identified from 494 patients (40%, 494/1235). The most common pathogen was Streptococcus pyogenes (27.6%,142/515), followed by Haemophilus influenzae (27.2%,140/515), Candida albicans (22.3%,115/515), Staphylococcus aureus (5.8%, 30/515) and Escherichia coli (4.7%,24/515). All S pyogenes isolates were sensitive to penicillin, whereas 53.7% (73/136) of H influenzae isolates were sensitive to ampicillin, and 70.4% (19/27) of S aureus isolates were sensitive to oxacillin. S pyogenes and H influenzae were the 2 most commonly identified pathogenic bacteria found in prepubertal girls with vulvovaginitis. Vulvovaginitis in prepubertal girls caused by C albicans may be more common in older children.

Short-term nitrogen dioxide exposure is associated with the spread of S. pyogenes-induced vulvovaginitis in prepubertal girls in Hangzhou, China.

As a cause of vulvovaginitis in prepubertal girls, Streptococcus pyogenes (S. pyogenes) is commonly isolated from vaginal introitus swabs. Studies have identified several risk factors, but have not focused on the correlation between ambient air pollutants and S. pyogenes-induced vulvovaginitis in prepubertal girls. This study was conducted to determine whether ambient air pollutants were associated with S. pyogenes-induced vulvovaginitis in prepubertal girls. Daily data about S. pyogenes-induced vulvovaginitis in prepubertal girls from the outpatient department of Children's Hospital at the Zhejiang University School of Medicine in Hangzhou City between January 1, 2015, and December 31, 2018, were retrospectively reviewed. Ambient air pollutants in Hangzhou were measured daily. A generalized additive model (GAM) was utilized to assess the associations between daily air pollutants and S. pyogenes isolates obtained from vaginal introitus swabs of prepubertal girls. The mean daily concentration of nitrogen dioxide (NO2) in Hangzhou City during the study period was 44.6 μg/m3 (25th-75th percentiles, 32.0-56.0 μg/m3). The GAM showed that the largest estimate effects in S. pyogenes-induced vulvovaginitis in prepubertal girls were found in NO2 with a moving (accumulative) average on day 3. The excess risk of NO2 in terms of the daily number of S. pyogenes isolates obtained from the vaginal introitus swabs was 14.91% (95% confidence interval [CI]: 4.85-25.94%) in the single-pollutant model. The multipollutant model revealed that an increase of 10 μg/m3 in NO2 exposure was associated with an 18.33% increased risk for acquiring S. pyogenes-induced vulvovaginitis in prepubertal girls (95% CI: 1.21-38.35%; P < 0.05). In conclusion, short-term NO2 exposure was strongly associated with the spread of S. pyogenes-induced vulvovaginitis in prepubertal girls.

Epidemiological Features and Antibiotic Resistance Patterns of Haemophilus influenzae Originating from Respiratory Tract and Vaginal Specimens in Pediatric Patients

Study ObjectiveHaemophilus influenzae (H. influenzae) is a common pathogen of respiratory tract infections in children, however, as a possible cause of vulvovaginitis in prepubertal girls, its epidemiological features, antibiotic-resistance patterns, and treatment are seldom noted. Design, Setting, Participants, Interventions, and Main Outcome MeasuresSpecimens obtained from patients were inoculated on Haemophilus selective medium; and drug-sensitivities tests were determined using the disk diffusion method. A cefinase disk was used to detect β-lactamase. ResultsA total of 610 H. influenzae strains, 81.6% (498/610) from the respiratory tract and 18.0% (110/610) from the vagina, were identified in the Children's Hospital in 2015. The age of the children with respiratory tract strains were significantly younger than those with vaginal strains (P < .001). The H. influenzae isolation rate in May was the highest. The β-lactamase positive rate was 51.5% (314/610), and 52.5% (320/610) were resistant to ampicillin. The susceptibilities rates to cefuroxime, ampicillin/sulbactam, cefotaxime, clarithromycin, and sulfamethoxazole-trimethoprim were 72.1% (440/610), 95.9%, 96.4% (588/610), 81.8% (499/610), and 36.4% (222/610), respectively. Higher resistance to ampicillin, cefuroxime, clarithromycin, and sulfamethoxazole-trimethoprim were found in respiratory tract strains, compared with vaginal strains (P < .05). All of the patients with H. influenzae in the respiratory tract were cured with oral or intravenous β-lactam antibiotics. Of all patients with vaginal strains, 50% (55/110) were cured with topical ofloxacin gel, and 44.5% (49/110) were cured with oral β-lactam antibiotics. ConclusionThe drug-resistance rates of H. influenzae isolated from vagina were lower than those from the respiratory tract. Topical ofloxacin gel or oral β-lactam antibiotics are effective treatments to eliminate the H. influenza causing infection in the vagina.

STREPTOCOCCUS PYOGENES AS THE CAUSE OF VULVOVAGINITIS IN ADULT WOMEN

According to the literature data, Streptococcus pyogenes is the most common cause of infectious vulvovaginitis in prepubertal girls, but it is rarely described in adult women. In this paper we report the prevalence of S. pyogenes vulvovaginitis in adult women in the municipality of Nis, Serbia, in a five-year period. The total of 42.259 women with symptoms of vulvovaginal infection were enrolled in the study and their swabs from the vagina and cervix were examined using the standard microbiological procedures: direct microscopy of Gram stained preparations and sample culture. Women with positive S. pyogenes findings were later contacted to give anamnestic data and for post-treatment control examinations. S. pyogenes was isolated from the samples of 2 patients: in July 2012 in a 20-year-old woman with the anamnesis of a previously diagnosed tonsillopharyngitis, and in May 2015 in a 32-year-old breast-feeding woman. These patients had the signs and symptoms of acute inflammation: vaginal and vulvar pain, dyspareunia, burning sensation, pruritus, and a profuse, watery, yellow vaginal discharge. Gram staining revealed abundant segmented WBCs and gram-positive cocci in pairs and chains. After the administered penicillin therapy, the control microbiological examinations of the vaginal and cervical swabs were done, as well as the throat swab culture for the presence of S.pyogenes, and all the results were negative. Streptococcal vulvovaginitis in adult women was diagnosed in only two examinees in our study and was associated with a predisposing factors: personal history of a respiratory infection and lactational vaginal atrophy.

Personal Hygiene and Vulvovaginitis in Prepubertal Children

Study ObjectiveTo determine and compare clinical and microbiological features of vulvovaginitis in prepubertal girls. Vulvovaginitis is the most common gynecological problem of childhood. Design, Setting, Participants, Interventions, and Main Outcome MeasuresThis study involved 45 girls from 2-12 (5.38 ± 2.9) years old; and 26 girls from 3-12 (5.72 ± 3.1) years old as a control group. Anamnesis and physical examination were followed by vaginal smear, urine culture, and stool analyses from both groups, and the personal hygiene status and education level of the mother were determined. ResultsThe most common symptoms among the patients were vaginal discharge (44.4%, vulvar erythema (37.8%), and vaginal itch (24.4%). Microorganisms, isolated from vaginal smears, were detected in 48.9% of the patients. Escherichia coli was shown in the urine culture of 3 patients with vulvovaginitis (6.70%). In microscopic stool analysis parasites were detected (45.9%). We found some relevant personal hygiene factors, such as wiping back to front (42.9%), cleaning by herself after defecation (89.3%), using toilet paper (60.7%) and wet wipes (21.4%), and bathing standing (14.3%) and sitting (46.4%) among patients. The questionnaire also showed that the children wore tight clothing (35.7%). ConclusionOur findings suggest that vulvovaginitis in prepubertal girls is related not only to microorganisms but also poor personal hygiene, the educational status of mothers, and specific irritants.

Microbiological aspects of vulvovaginitis in prepubertal girls

This study aimed to establish the vaginal introitus microbial flora in girls with and without symptoms of vulvovaginitis, and to present the distribution of isolated microorganisms by age groups in girls with vulvovaginitis. We enrolled 500 girls with vulvovaginitis symptoms, aged 2-12 years, referred by their pediatricians for microbiological examination of the vaginal introitus swabs, and 30 age-matched asymptomatic girls. Similar microbial flora was isolated in both groups, but the symptomatic girls had significantly more common positive microbiological findings compared to controls (p < 0.001). In symptomatic girls, the following pathogenic bacteria were isolated: Streptococcus pyogenes (4.2%), Haemophilus influenzae (0.4%), and Staphylococcus aureus (5.8%). Bacteria of fecal origin were found in vaginal introitus swabs in 33.8% of cases, most commonly Proteus mirabilis (14.4%), Enterococcus faecalis (12.2%), and Escherichia coli (7.0%). The finding of fecal flora was more common compared to controls, reaching a statistical significance (p < 0.05), as well as in girls aged up to 6 years (p < 0.001). Candida species were found in 2.4% of girls with vulvovaginitis symptoms. The microbial ecosystem in girls with clinical signs of vulvovaginitis is complex and variable, and the presence of a microorganism does not necessarily imply that it is the cause of infection. The diagnosis of vulvovaginitis in prepubertal girls requires a complex and comprehensive approach, and microbiological findings should be interpreted in the context of clinical findings.

Clinical and microbiological features of Haemophilus influenzae vulvovaginitis in young girls

Aims: To define the clinical and microbiological features of vulvovaginitis in prepubertal girls whose genital swabs yielded Haemophilus influenzae. Methods: Laboratory based study and retrospective collection of clinical data from...

788 NONSPECIFIC VAGINITIS (NSV) IS AN IMPORTANT CAUSE OF VAGINITIS IN CHILDREN

In most published studies an etiology has been defined in less than half of cases of vulvovaginitis in prepubertal girls. NSV,a synergistic infection involving Gardnerella vaginalis and anaerobic bacteria, is a common cause of vaginitis in adults, but has not been described in children. We studied 17 girls, age 2-11 yrs. (mean-5-5 yr), who presented because of vulvovaginitis; 5 of these girls were known or suspected of to have been sexually abused. Cultures were examined for bacteria, including Chlamydia trachomatis, viruses, yeasts and Trichompnas vaginalis. In addition, a vaginal wash specimen was also examined. NSV was diagnosed if the wash contained “clue cells” and gave off a fishy odor when 10% KOH was added.We were able to make a microbial diagnosis in 11/17 (65%) pts:3 of 4 girls with NSV were successfully treated with metronidazole with reversion of the vaginal wash to normal.NSV was the most frequent identifiable cause of vaginitis in these children.The results of this study also illustrated the value of the vaginal wash specimen for the diagnosis of vaginitis in prepubertal girls.

Nonvenereal Transmission of Gonococcal Vaginitis

I read with great interest the timely article by Drs. Auman and Waldenberg, "Gonococcal Periappendicitis and Salpingitis in a Prepubertal Girl" (Pediatrics 58:287, August 1976), which deals with the important problem of Neisseria gonorrhoeae as an etiological factor of vaginitis and its complications in a 5-year-old girl. Vaginal discharge and penile discharge in young children, irrespective of age, should be cultured in appropriate media for N. gonorrhoeae in addition to those for other organisms. According to Kotcher et al.,1 the gonococcus was the only significant bacterial etiological agent in 57 cases of vulvovaginitis in prepubertal girls.