[Anogenital lesions produced by Human Papillomavirus. Prevalence study in children and adolescent not vaccinated]. / Lesiones anogenitales por Virus Papiloma Humano. Estudio de prevalencia en niños, niñas y adolescentes no vacunados.

In Chilean children and adolescents, human papillomavirus (HPV) infection prevalence is unknown. In 2014, the HPV vaccine was incorporated into the National Immunization Program for girls, and since 2019 for boys. OBJECTIVE: To determine the prevalence, genotypes, and characteristics of HPV infection in children and adolescents with anogenital lesions not vaccinated against HPV. PATIENTS AND METHOD: Children and adolescents with anogenital lesions who consulted at the Luis Calvo Mackenna Children's Hospital between 2013 and 2017 were studied. The reason for consultation, age, sex, family history of HPV lesions, history of sexual abuse, and consensual sexual activity were recorded. HPV was detected by PCR and typification by reverse hybridization of the L1 gene. The samples were analyzed in the Oncogenic Virus Section of the Institute of Public Health. RESULTS: 110 patients were studied; 44.5% were children. HPV was detected in 34 cases (30.9% [CI95% 22.4- 40.4]), 22 (44.9%) were children and 12 (19.7%) adolescents. Eleven (91.7%) adolescents had a history of sexual con tact (p < 0.005); 4 (18.2%) children disclosed sexual abuse. HPV was found in 25% of patients with genital lesions and 50% with perianal lesions (p < 0.015). The most frequent genotypes were 59, 58, 16, 18, 6, and 11. Only low-risk genotypes were detected in children and high-risk genotypes were detected in 11/12 (91.7%) of HPV (+) adolescents. CONCLUSION: The prevalence of HPV infection was 30%. In adolescents, the infection was related to sexual contact and high-risk HPV. In children, it was associated with low-risk genotypes. Perianal lesions are more frequently associated with HPV infec tion than genital lesions in children and adolescents. The visual inspection does not allow to specify the etiology of the genital lesions, so it is necessary to perform a PCR test for HPV.

Diagnóstico y manejo de Himen Imperforado en una lactante menor / Diagnosis and management of Imperforated Hymen in an infant

INTRODUCCIÓN: El himen imperforado es la malformación congénita más frecuente del tracto genital femenino. La mayoría de los casos no se pesquisan en la infancia, debido a un examen genital insuficiente. Su diagnóstico y resolución deben ser precoces y definitivas para evitar complicaciones posteriores. OBJETIVO: Presentar el caso de una lactante portadora de himen imperforado, y actualizar la información sobre las técnicas de examen genital para detectar esta patología en forma precoz y su tratamiento. CASO CLÍNICO: Lactante de 3 meses, consultó por aumento de volumen protruyente en la zona del introito. En el examen físico se realizó maniobra de valsalva que dio salida a una masa homogénea, nacarada de superficie lisa, entre los labios mayores, sugerente himen imperforado. Se complementó el estudio con ultrasonido ginecológico, el que demostró la presencia de hidrocolpos, descartando otras anomalías. Se realizó una himenotomía, que dio salida a abundante material seroso, sin mal olor, y luego se completó la himenectomía mediante la resección de la membrana himeneal. En control al 4to mes posterior a la intervención se constató un himen ampliamente permeable. CONCLUSIÓN: Los equipos de atención neonatal, requieren capacitación acerca de la técnica correcta del examen genital externo de la recién nacida y lactante. La himenectomía es la técnica que permite resolver definitiva mente el cuadro evitando complicaciones.

INTRODUCTION: Imperforated hymen is the most frequent congenital malformation of the female genital tract. Most cases are not investigated in childhood, due to an insufficient genital examination. Its diagnosis and resolution must be early and definitive to avoid subsequent complications. OBJECTIVE: A clinical case of an infant with imperforated himen is presented. To update on genital examination technique necessary to detect this pathology in the newborn and infants, and the proper treatment. CLINICAL CASE: 3-months-old infant that consulted due to an increase in bulging volume in the introitus area. In the physical examination, the Valsalva's maneuver was performed allowed the ex pulsion of a homogeneous pearly mass with a smooth surface, between the labia majora, suggesting imperforate hymen. The study was complemented with gynecological ultrasound, which demons trated the presence of hydrocolpos, ruling out other anomalies. A hymenotomy was performed, which allowed for the evacuation of abundant serous material, with no bad smell, and then the hymenectomy was completed by resection of the hymenal membrane. In follow-up monitoring 4 months after the intervention, a widely permeable hymen was found. CONCLUSION: Neonatal care teams require training on the correct technique of external genital examination of the newborn and infant. Hymenectomy is the technique that allows definitely resolving the condition, avoiding complications.

[Diagnosis and management of Imperforated Hymen in an infant]. / Diagnóstico y manejo de Himen Imperforado en una lactante menor.

INTRODUCTION: Imperforated hymen is the most frequent congenital malformation of the female genital tract. Most cases are not investigated in childhood, due to an insufficient genital examination. Its diagnosis and resolution must be early and definitive to avoid subsequent complications. OBJECTIVE: A clinical case of an infant with imperforated himen is presented. To update on genital examination technique necessary to detect this pathology in the newborn and infants, and the proper treatment. CLINICAL CASE: 3-months-old infant that consulted due to an increase in bulging volume in the introitus area. In the physical examination, the Valsalva's maneuver was performed allowed the ex pulsion of a homogeneous pearly mass with a smooth surface, between the labia majora, suggesting imperforate hymen. The study was complemented with gynecological ultrasound, which demons trated the presence of hydrocolpos, ruling out other anomalies. A hymenotomy was performed, which allowed for the evacuation of abundant serous material, with no bad smell, and then the hymenectomy was completed by resection of the hymenal membrane. In follow-up monitoring 4 months after the intervention, a widely permeable hymen was found. CONCLUSION: Neonatal care teams require training on the correct technique of external genital examination of the newborn and infant. Hymenectomy is the technique that allows definitely resolving the condition, avoiding complications.

Infecciones de transmisión sexual: experiencia en una unidad de ginecología pediátrica / Sexual transmitted diseases: experience in a paediatric gynaecological department

Las infecciones vulvovaginales (VV) constituyen uno de los problemas más frecuentes e importantes en la morbilidad ginecológica pediátrica. La presente comunicación tiene por objeto dar a conocer la experiencia de la Unidad de Ginecolgía Pediátrica del Hospital Dr. Luis Calvo Mackenna y la evolución que han presentado las VV específicas por agentes de transmisión sexual (infecciones de transmisión sexual (ITS) o ITS potenciales), durante la última década. Se da conocer los resultados de diferentes estudios realizados en población menor de 15 años, en cuanto a gonorrea, tricomoniasis, Chlamydia tracomatis, Condiloma genital, Virus Herpes y Micoplasmas urogenitales. Se hace referencia a su relación con abuso sexual y se compara con lo encontrado en la literatura.

Patologías ginecológicas frecuentes en pediatría / Frequent gynecologic pathologies in pediatrics

Los problemas ginecológicos en las diferentes edades de las pacientes pediátricas constituyen una patología que el pediatra debe manejar adecuadamente, diferenciando las situaciones normales o fisiológicas, de las que requieren mayor estudio o control de la evolución. En este artículo, el médico encuentra una útil orientación y recuerdo de la fisiología para el enfrentamiento de trastornos frecuentes, de las cuales a veces las madres por diferentes razones no consultan o la adolescente con dificultad llega a la consulta

Etiología de la vulvovaginitis en la edad pediátrica / Etiology of vulvovaginitis in pediatric age

Se describen los hallazgos obtenidos en los examenes bacteriológicos, micológicos y parasitológicos en 100 niñas que consultaron por vulvovaginitis a la unidad de ginecología pediátrica del Hospital Luis Calvo Mackenna entre los meses de noviembre de 1988 a julio de 1989. En todas las pacientes se obtuvieron muestras de secreción vaginal para estudio de bacterias, hongos y trichomonas y en 55 se realizó la prueba de Graham con cinta adhesiva transparente para detección de huevos de Enterobius vermicularis en el área perianal. Se consiguió identificar al presunto agente etiológico en 81%de los casos, correspondiendo éste en 68%a bacterias, en 4%a hongos, 1%trichomonas vaginalis y 8%Enterobius vermicularis