Vulvovaginitis in the Prepubertal Child

Parental experiences of their child's vulvovaginitis: a qualitative interview study

INTRODUCTION

Vulvovaginitis is described as a common self-limiting paediatric gynaecological condition. Parents' experiences of their child being diagnosed with this condition and subsequent treatment have not previously been described.

AIM

The aim of this study was to explore parents' experiences of their child's diagnosis and management of vulvovaginitis.

STUDY DESIGN

The study was conducted in the north west of England over a two-year period. Qualitative data were generated by semistructured in-depth interviews. Mothers of nine children with vulvovaginitis consented to participate. Data were analysed using thematic analysis.

RESULTS

The analysis of the data resulted in four themes: trauma and uncertainty of initial symptoms, seeking a diagnosis; an uncertain journey, managing the symptoms; a process of trial and error and managing the impact; keeping it private. Parents experienced a difficult and protracted journey to their child's diagnosis and were involved in a process of trial and error to try and monitor and manage what can be a difficult ongoing condition.

DISCUSSION

Clinical reports suggest that vulvovaginitis is a minor childhood condition; this is not necessarily the perceptions and experiences of parents, who can experience uncertainty and ongoing difficulty after their child's diagnosis.

CONCLUSION

The diagnosis of vulvovaginitis can have a major and ongoing impact on children's and their family's lives.

Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children

BACKGROUND

Streptococcus pyogenes (group A Streptococcus) is the etiological agent of perineal infection in children, consisting of perianal infection, vulvovaginitis and balanitis. If it is not properly diagnosed and treated, it can persist for many months and can cause severe complications. Furthermore, treatment with penicillin can be followed by failures and recurrences.

METHODS

We report here the prevalence of S. pyogenes isolates in genital tract specimens from girls (n = 1692) with symptoms of vulvovaginitis and from boys (n = 52) with balanitis in the municipality of Nis, Southeast-Serbia (the Western Balkans) in a 10 year period, and the seasonal distribution, patient age and sensitivity to bacitracin and antimicrobial drugs used in the treatment of streptococcal infection.

RESULTS

Streptococcal vulvovaginitis was diagnosed in 2.30% of examinees. Of those cases, 64.10% were detected from April to September, and it was most common (71.79%) in girls aged 3-7 years. Streptococcal balanitis was diagnosed in two instances: in a 4-year-old boy and in a 7-year-old boy. S. pyogenes strains resistant to bacitracin were identified in five girls. Two isolates with M phenotype and five isolates with cMLS_B phenotype were identified.

CONCLUSIONS

Streptococcal vulvovaginitis was diagnosed less often in the present study, but it was still far more common than streptococcal balanitis in childhood. Bacitracin resistance of S. pyogenes strains should be taken into account in routine microbiological identification, and the detection of S. pyogenes isolates resistant to erythromycin requires surveillance in the present geographical territory.

Guttate Psoriasis Following Streptococcal Vulvovaginitis in a Five-year-old Girl

BACKGROUND

Guttate psoriasis is frequently associated with a preceding pharyngeal or perianal streptococcal infection in children. Despite Group A beta-hemolytic streptococci (GABHS) being the most common cause of specific bacterial vulvovaginitis in prepubertal girls, there are no reports of streptococcal vulvovaginitis triggering guttate psoriasis.

CASE

A five-year-old girl presented with guttate psoriasis following an episode of Streptococcal pyogenes vulvovaginitis. Following antibiotic treatment and bacterial eradication she developed vulvar psoriasis that resolved with high potency topical steroids.

SUMMARY AND CONCLUSION

Identification of an antecedent streptoccocal infection can help predict the long term prognosis in children with guttate psoriasis. The vulvovaginal area should be considered as a source of GABHS infection in young girls with guttate psoriasis, and cultures should be considered if symptoms are present.

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.

CONCLUSION

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.

Urogenital symptoms in premenarchal girls: parents' and girls' perceptions and associations with irritants

OBJECTIVES

Premenarchal girls commonly seek care for urogenital symptoms, yet little is published about parents' and girls' perceived causes of symptoms or associations with irritant exposures. We sought to describe urogenital symptoms, perceived causes, and associations between symptoms and genital irritant exposures.

DESIGN

Descriptive study. Parents/girls interviewed; medical records reviewed.

PARTICIPANTS

Five- to 12-year-old well, premenarchal girls and their parents.

SETTING

One urban and 1 suburban pediatric practice.

OUTCOME MEASURES

Prevalence of histories of urogenital symptoms and perceived causes; association between symptoms and exposure to genital irritants in a well population.

RESULTS

Of 191 parent/girl dyads, 33% of parents and 48% of girls reported girls' histories of urogenital symptoms not attributed to urinary tract infections or trauma. Perceived causes: poor hygiene (29% of parents vs 14% of girls); soap products (20% of parents and girls); none identified (24% of parents vs 53% of girls). Analysis of symptoms versus irritant exposures demonstrated these associations: dysuria and genital soreness with poor genital hygiene, tight garments, or exposure to soap products; genital pruritus with poor hygiene (all P < .05). No symptoms were associated with nylon underwear, tights, or bike or horseback riding. Vaginal discharge was not associated with any irritants.

CONCLUSION

Almost half the girls had histories of urogenital symptoms. Poor hygiene and soap exposure were perceived causes of most symptoms. When no cause for urogenital symptoms is identified, treatment should be focused on hygiene, soap exposure, and tight-fitting clothes, not on bike or horseback riding or wearing nylon underwear or tights. Vaginal discharge warrants further evaluation.