Evaluation of vulvovaginitis in prepubertal girls referred to pediatric neophrology clinic

ABSTRACT

The aim of this study is evaluation of clinical findings, microscopic examination and culture of vaginal secretions, and response to treatment in prepubertal girls with vulvovaginitis. Over a period of about 5 years in a clinic for pediatric kidney and urinary tract disease 157 girls aged 2.5 8 years with urogenital symptoms were studied prospectively. Dysuria, erythema, itching, soreness, and vaginal discharge were genital symptoms and signs. Pathogenic bacteria were isolated in 27% of cases and streptococcus pyogenes was a common agent. Nonpathogenic enteric flora was isolated in about 43%. There was no growth of bacteria in 30%. Poor hygiene was an associated risk factor in those with nonpathogenic positive culture [p=0.001]. There was statistically significant difference of purulent vaginal discharge between cases with vulvovaginal pathogenic infection and those with negative culture [P<0.001]. Also there was significant difference of observing WBC in vaginal smears between those with pathogenic bacteria and patients who had no growth of pathogens [P<0.001]. Candida and sexually transmitted agents were not found in any of the girls. Labial fusion was not an uncommon abnormality. Simple measures to improve hygiene and use of local estrogen were effective in the patients with nonpathogenic and nonspecific etiology. Physical examination of genital area should be done in all girls with genitourinary symptoms. Antibiotics should be prescribed based on bacteriologic culture of vaginal secretion. Advice about hygiene practices and local estrogen is the most effective policy in children with noninfectious vulvovaginitis. Anti fungal creams usually have not place in the initial management of childhood vulvovaginitis. The possibility of sexual abuse or foreign body in vagina must be considered particularly if the vulvovaginitis is persistent or recurrent after adequate treatment, but our data indicate they are not contributory factors