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Short A, Sit A, Gerstl B, Mallinder H, Deans R. Vaginoscopy to investigate vaginal bleeding and discharge in prepubertal girls. Aust N Z J Obstet Gynaecol 2024. [PMID: 39234926 DOI: 10.1111/ajo.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/11/2024] [Indexed: 09/06/2024]
Abstract
STUDY OBJECTIVE To investigate the aetiology of vaginal bleeding and discharge in prepubescent girls, and the utility of vaginoscopy for making a diagnosis. DESIGN Retrospective observational study over 14 years. SETTING Two major tertiary referral paediatric hospitals in Sydney, Australia. PARTICIPANTS All prepubescent girls (n = 104) who presented with vaginal bleeding and/or discharge and subsequently underwent a vaginoscopy. A total of 120 procedures were performed. MAIN OUTCOME MEASURES Surgical findings at vaginoscopy; number needed to investigate (NNI) to establish a diagnosis and to exclude malignancy. RESULTS There were 52/120 (43.3%) vaginoscopies which provided a positive diagnosis, including 36/86 (41.8%) performed for bleeding and 16/34 (47.0%) for vaginal discharge. In the vaginal bleeding group, the causes found were a foreign body in 11/86 (12.7%), vulvovaginitis in 6/86 (6.9%), benign Mullerian papilloma in 5/86 (5.8%), trauma in 4/86 (4.6%), and malignant tumours in 2/86 (2.3%). To establish a diagnosis in girls presenting with vaginal bleeding, the NNI was 2.4; to detect a malignancy the NNI was 43.0. In girls presenting with vaginal discharge, vulvovaginitis was noted intraoperatively in 7/34 (20.6%) and a foreign body was found in 7/34 (20.6%). No malignant tumours were identified in the vaginal discharge group. To establish a diagnosis in girls presenting with vaginal discharge, the NNI was 2.1. CONCLUSIONS Vaginoscopy is an important diagnostic tool in the setting of vaginal bleeding in prepubescent girls, allowing the ability to confirm a diagnosis, and importantly, to exclude malignancy.
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Affiliation(s)
- Asha Short
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Gynaecology, The Royal Hospital for Women, Randwick, New South Wales, Australia
- Department of Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Andrea Sit
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Brigitte Gerstl
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Gynaecology, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Hayley Mallinder
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Gynaecology, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Rebecca Deans
- School of Women's and Children's Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Gynaecology, The Royal Hospital for Women, Randwick, New South Wales, Australia
- Department of Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Davoodi L, Soleymani E, Oladi Z, Azar SS, Parandin F, Mizani A, Mirbadie SR, Hajizadeh F, Fakhar M. Vulvovaginitis due to Enterobius vermicularis in a girl and epidemic enterobiasis in her family. Clin Case Rep 2024; 12:e8902. [PMID: 38725928 PMCID: PMC11079541 DOI: 10.1002/ccr3.8902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
Key Clinical Message Here we present a case of a 4-year-old girl who suffered from vulvovaginitis caused by Enterobius vermicularis. All members of her family were also infected by this helminth. Treatment with mebendazole was administered to all family members and it was found that the entire family had been cured. Abstract Vulvovaginitis, an inflammation of the vulvovaginal mucous membranes, is a common reason for pediatric gynecology consultations. One of the causes of this condition is a parasitic worm known as Enterobius vermicularis (E. vermicularis). In girls, adult worms can infiltrate the vagina and release eggs, leading to the development of vulvovaginitis. Furthermore, these worms have the ability to invade the endometrial cavity too. Here we present a case of a 4-year-old girl who suffered from vulvovaginitis caused by E. vermicularis. All members of her family were also infected by this parasitic helminth. In the vaginal sample, apart from the eggs, the female adult worm was observed under the microscope. Treatment with mebendazole was administered to all family members, and their progress was followed for a period of 3 weeks, during which it was found that the entire family had been cured. This patient experienced significant improvement in symptoms related to severe anxiety, nervousness, vaginal inflammation, itching, and vulvovaginitis caused by E. vermicularis. To prevent infection by E. vermicularis, it is crucial to disinfect underwear and bed sheets. In kindergartens, the spread of this parasite should not be underestimated, and asymptomatic individuals who have been exposed to infected persons should receive treatment to prevent an epidemic. Maintaining cleanliness and hygiene, especially after using the toilet, is of the most importance, particularly for girls who are more susceptible to E. vermicularis infection. Additionally, it is essential for all family members to be aware of the transmission routes of this parasite.
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Affiliation(s)
- Lotfollah Davoodi
- Department of Infectious Diseases, Faculty of MedicineAntimicrobial Resistance Research Center, Mazandaran University of Medical SciencesSariIran
| | - Eissa Soleymani
- Department of Parasitology, Toxoplasmosis Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
| | - Ziaeddin Oladi
- Department of Internal Medicine, Faculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Shadi Shayesteh Azar
- Department of Infectious Diseases, Faculty of MedicineAntimicrobial Resistance Research Center, Mazandaran University of Medical SciencesSariIran
| | - Fatemeh Parandin
- Research Center for Environmental Determinants of Health (RCEDH)Health Institute, Kermanshah University of Medical SciencesKermanshahIran
| | - Azadeh Mizani
- Department of ParasitologyPasteur Institute of IranTehranIran
| | | | - Fatemeh Hajizadeh
- Department of Parasitology, Toxoplasmosis Research CenterCommunicable Diseases Institute, Mazandaran University of Medical SciencesSariIran
| | - Mahdi Fakhar
- Iranian National Registry Centre for Lophomoniasis and ToxoplasmosisImam Khomeini Hospital, Mazandaran University of Medical SciencesSariIran
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Baka S, Demeridou S, Kaparos G, Tsoutsouras K, Touloumakos S, Dagre M, Meretaki S, Chasiakou A, Koumaki V, Tsakris A. Microbiological findings in prepubertal and pubertal girls with vulvovaginitis. Eur J Pediatr 2022; 181:4149-4155. [PMID: 36163515 PMCID: PMC9649474 DOI: 10.1007/s00431-022-04631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 11/03/2022]
Abstract
Vulvovaginitis is a common and challenging gynaecological problem in prepubertal and pubertal girls. Such an infection, owing to a wide range of aetiologies, if not responding to hygienic measures, needs further investigation through vaginal cultures, since treatment should be tailored accordingly. This study aimed to investigate the pathogens isolated in prepubertal and pubertal girls with signs and symptoms of vulvovaginitis. A total of 2314 symptomatic girls, 1094 prepubertal and 1220 pubertal, aged 2 to 16 years, were included. Vaginal samples were inoculated on specific culture plates followed by incubation in aerobic, anaerobic or CO2 atmosphere at 37 °C for 24 or 48 h, as appropriate. The identification of the isolated pathogens was carried out using Gram stain, conventional methods and the automated system VITEK 2 (BioMerieux, Marcy l'Etoile, France). Positive cultures were obtained from 587 (53.7%) of prepubertal girls and 926 (75.9%) of pubertal girls. A total of 613 and 984 pathogens were detected in prepubertal and pubertal subjects, respectively. Isolated bacteria included 40.1% and 22.8% Gram-positive cocci, 35.6% and 24.8% Gram-negative rods in the prepubertal and pubertal groups, respectively, with faecal pathogens being the most prevalent. Bacterial vaginosis was diagnosed in 22.8% of prepubertal and 37.9% of pubertal girls. Candida species were isolated mostly in the pubertal girls (14.5%). CONCLUSION Culture results should be evaluated with caution in children with vulvovaginitis. In the prepubertal girls, the most common isolated pathogens were opportunistic bacteria of faecal origin while girls in late puberty were more susceptible to bacterial vaginosis and vulvovaginal candidiasis. WHAT IS KNOWN • Vulvovaginitis is the most frequent and challenging reason for referral to paediatric and adolescent gynaecology services. • Microbiological examination can prove to be a significant tool to help diagnosis although results should be evaluated with caution in children. WHAT IS NEW • Significantly more positive vaginal cultures and pathogens were recorded in symptomatic pubertal girls compared to prepubertal children. • The prevalence of bacterial vaginosis was increased in both prepubertal and pubertal girls with vulvovaginitis although significantly more in girls at puberty.
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Affiliation(s)
- Stavroula Baka
- Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528, Athens, Greece.
| | - Stiliani Demeridou
- Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528, Athens, Greece
| | - George Kaparos
- Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528, Athens, Greece
| | - Konstantinos Tsoutsouras
- Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528, Athens, Greece
| | - Sotirios Touloumakos
- Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528, Athens, Greece
| | - Maria Dagre
- Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528, Athens, Greece
| | - Sofia Meretaki
- Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528, Athens, Greece
| | - Anthia Chasiakou
- Department of Biopathology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 76, Vasilisis Sofias Avenue, 11528, Athens, Greece
| | - Vasiliki Koumaki
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Street, Athens, 11527, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias Street, Athens, 11527, Greece
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Clinical Symptoms and Microbiological Findings in Prepubescent Girls with Vulvovaginitis. J Pediatr Adolesc Gynecol 2022; 35:629-633. [PMID: 35820605 DOI: 10.1016/j.jpag.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The 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 OBJECTIVE This study retrospectively evaluated genital microbiological findings in prepubescent girls with vulvovaginitis and then compared the findings to healthy controls without discharge. METHODS This 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. RESULTS Of 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%). CONCLUSIONS Among 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.
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Pyometra: Atypical cause of pediatric abdominal pain following complicated appendicitis. Am J Emerg Med 2022; 57:235.e1-235.e4. [PMID: 35459562 DOI: 10.1016/j.ajem.2022.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/18/2022] Open
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Kolalapudi S, Shaik H, Kolaka S, Konala S, Alluri R. Cotton fiber ball as an unusual cause of vaginal discharge in a 5-year-old child. Indian J Sex Transm Dis AIDS 2022; 43:79-81. [PMID: 35846523 PMCID: PMC9282714 DOI: 10.4103/ijstd.ijstd_116_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 05/09/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022] Open
Abstract
Vaginal discharge in children can be due to many causes. Foreign body in vagina is an unusual cause. Foul-smelling, blood-stained vaginal discharge should raise the suspicion of foreign body in vagina. Magnetic resonance imaging (MRI), vaginal examination under general anesthesia may detect foreign bodies in vagina. We found a cotton fiber ball in vagina, probably caused by the child's teddy bear as a cause of vaginal discharge in a 5-year-old child. A repeat MRI suggested foreign body in the vagina and vaginal exploration under general anesthesia helped for the removal of cotton fiber ball, which led to complete clearance of the vaginal discharge in the child.
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Gynaecological infections in paediatric and adolescent gynaecology: a review of recommendations. Postepy Dermatol Alergol 2021; 38:734-739. [PMID: 34849117 PMCID: PMC8610037 DOI: 10.5114/ada.2021.110084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
Inflammation within the genital organs in women is an important problem in gynaecology and venereology. Understanding the factors contributing to the inflammatory process and the role of defence mechanisms against their occurrence is important in terms of prevention and treatment. It is especially visible in paediatric gynaecology, where inflammatory diseases of the vulva, dermatoses, injuries and the effects of possible sexual harassment may overlap.
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8
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Chanchlani N, Hodes D. Fifteen-minute consultation: Vulval soreness in the prepubertal girl. Arch Dis Child Educ Pract Ed 2021; 106:333-340. [PMID: 33246924 DOI: 10.1136/archdischild-2019-316905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/21/2020] [Accepted: 10/22/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Neil Chanchlani
- Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK .,Exeter IBD Pharmacogenetics, Exeter, UK
| | - Deborah Hodes
- Paediatrics, University College London Hospitals NHS Foundation Trust, London, UK
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9
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Yavaş DP, Arslansoyu Çamlar S, Soylu A, Kavukçu S. Clinical predictive value of the urine leukocyte esterase test positivity in childhood. Pediatr Int 2021; 63:1334-1338. [PMID: 33548092 DOI: 10.1111/ped.14643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/25/2020] [Accepted: 02/01/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND False negative or positive results may occur in the urine dipstick test for leukocyte esterase (LE), which is used to determine urinary tract infection (UTI). We aimed to investigate the clinical importance of the presence or absence of pyuria in urine sediment for diagnosing UTI in the presence of positive LE in dipstick analysis. METHODS Patients admitted to the pediatric nephrology outpatient clinic with positive urine LE tests were divided into two groups: those without pyuria (Group 1) and those with pyuria (Group 2) in their urine sediment. Hospital files of the patients were evaluated retrospectively for demographic variables, lower or upper UTI symptoms, physical examination for phimosis and vulvovaginitis, urinalysis for LE and nitrite tests, urine sediment microscopy, urine culture, complete blood count and C-reactive protein. Both groups were compared for the significant growth of pathogenic bacteria in urine cultures along with clinical and laboratory parameters. RESULTS Among 578 children giving samples for urinalysis, there were 287 cases with positive LE tests. Groups 1 and 2 included 123 and 164 cases, respectively. The proportion of girls was higher in Group 1 and vulvovaginitis rate was higher among the girls in Group 1. Girls with vulvovaginitis were mostly prepubertal. Upper UTI symptoms, significant pathogen growth rate, and elevated acute phase response were more common in Group 2. In addition, the phimosis rate was more common among the boys in Group 1 with false positive LE test. CONCLUSIONS Children with positive LE tests without pyuria are mostly prepubertal girls and there is a high rate of vulvovaginitis in these girls. Unnecessary tests and treatments for UTI may be avoided with detailed history and physical examination in prepubertal girls who have a false positive LE test. We also found, for the first time, that a false positive LE test is significantly associated with phimosis in boys.
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Affiliation(s)
- Damla Pınar Yavaş
- Department of Pediatrics, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Seçil Arslansoyu Çamlar
- Division of Nephrology, Department of Pediatrics, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Alper Soylu
- Division of Nephrology, Department of Pediatrics, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Salih Kavukçu
- Division of Nephrology, Department of Pediatrics, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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Zhang Y, Liu T, Lin J, Yu F, Hu Z. STROBE-sequencing analysis of the vaginal microecology of 4- to 6-year-old girls in Southwest China. Medicine (Baltimore) 2021; 100:e25362. [PMID: 33787640 PMCID: PMC8021340 DOI: 10.1097/md.0000000000025362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
We investigated the vaginal flora diversity of preschool-aged (ie, 4-6-year-old) girls in southwest China.Fourteen preschool-aged girls were enrolled in this study. The statuses and differences in their vaginal flora were evaluated by Gram staining, bacterial culturing, and sequencing analysis.Gram staining and microbial culturing showed that the main vaginal flora of the preschool-aged girls were Gram-negative bacilli, whereas the main vaginal flora of healthy adult controls were large Gram-positive bacilli such as Lactobacillus crispatus. Shannon and Simpson indexes indicated that the bacterial diversity tended to decrease with age. The species abundance heat map showed that the vaginal microecology of the girls differed slightly at different ages but mainly comprised Pseudomonas, Methylobacterium, Sphingomona,s and Escherichia. The functional abundance heat map indicated that the bacterial functions increased with age.The vaginal microecology of preschool-aged girls differs from that of adults. A comprehensive understanding of the vaginal flora diversity of preschool-aged girls will aid in clinically diagnosing vulvovaginitis in preschool-aged girls.
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Affiliation(s)
- Yiduo Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ting Liu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jingying Lin
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Fan Yu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zhengqiang Hu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Jarienė K, Drejerienė E, Jaras A, Kabašinskienė A, Čelkienė I, Urbonavičienė N. Clinical and Microbiological Findings of Vulvovaginitis in Prepubertal Girls. J Pediatr Adolesc Gynecol 2019; 32:574-578. [PMID: 31445141 DOI: 10.1016/j.jpag.2019.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/12/2019] [Accepted: 08/15/2019] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To evaluate genital microbiological findings in prepubertal girls with vulvovaginitis and in healthy controls. DESIGN Prospective case-control study. SETTING Pediatric Outpatient unit of the Department of Pediatrics of the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos from November 2014 to May 2017. PARTICIPANTS Fifty-two prepubertal girls aged 1-9 years diagnosed with vulvovaginitis, and 42 age-matched healthy controls. INTERVENTIONS AND MAIN OUTCOME MEASURES Samples for microbiological culture were collected using sterile cotton swabs from the introitus and the lower third of the vagina from all study participants. Microbiological findings were analyzed according to bacteria type and intensity of growth. RESULTS Most of the vaginal microbiological swab results were positive for bacterial growth: 47 (90.4%) and 34 (80.9%) were similar in the study and control groups, respectively (P = .24). Sixteen (30.8%) and 9 (21.4%) of the microbiological traits results in the case and control groups, respectively, were regarded as potential causative agents (P = .27). Streptococcus pyogenes was the most frequent pathogen in the study group (P = .03); all other microorganisms detected as either a pure or dominant growth in the control group, were considered opportunistic. CONCLUSIONS Vaginal bacterial culture results were positive in prepubertal girls with vulvovaginitis and in healthy controls. Nonspecific vulvovaginitis without a dominant/isolated pathogen was seen to be more common than vulvovaginitis with a potential causative agent. Clinical symptoms were more frequent among girls when the potential infectious agent was identified.
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Affiliation(s)
- Kristina Jarienė
- Obstetrics and Gynecology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Eglė Drejerienė
- Obstetrics and Gynecology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Algirdas Jaras
- Psychiatry Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Austė Kabašinskienė
- Obstetrics and Gynecology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ieva Čelkienė
- Obstetrics and Gynecology Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
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12
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McKenna J, Bray L, Doyle S. Parental experiences of their child's vulvovaginitis: a qualitative interview study. J Pediatr Urol 2019; 15:659.e1-659.e5. [PMID: 31451410 DOI: 10.1016/j.jpurol.2019.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- J McKenna
- Nurse Education, Edge Hill University, Ormskirk, UK.
| | - L Bray
- Child Health Literacy, Edge Hill University, Ormskirk, UK
| | - S Doyle
- Child Health Literacy, Edge Hill University, Ormskirk, UK
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13
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Ritchie JK, Latthe P, Jyothish D, Blair JC. The paediatrician and the management of common gynaecological conditions. Arch Dis Child 2018; 103:703-706. [PMID: 29545410 DOI: 10.1136/archdischild-2017-314375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 01/15/2023]
Abstract
Paediatric gynaecology is an emerging discipline. Since 2000, there has been an advanced training programme in paediatric gynaecology available for obstetric and gynaecology trainees; additionally, a set of clinical standards 1 for the care of paediatric and adolescent patients has been developed by The British Society of Paediatric and Adolescent Gynaecology (BritSPAG). BritSPAG is a multidisciplinary group of professionals including gynaecologists, paediatricians, paediatric urologists and endocrinologists.Girls with gynaecological conditions are often seen in general paediatric services; it is important that those assessing them are confident in identifying patients who require more specialist care. Despite this, gynaecology does not appear in the Royal College of Paediatrics and Child Health curriculum. This article aims to increase the knowledge base and confidence of paediatricians in dealing with common paediatric and adolescent gynaecological conditions.
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Affiliation(s)
- Joanne K Ritchie
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford NHS Trust, Princess Royal Hospital, Telford, UK
| | - Pallavi Latthe
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Trust, Birmingham Women's Hospital, Birmingham, UK
| | - Deepthi Jyothish
- Department of General Paediatrics, Birmingham Women's and Children's NHS Trust, Birmingham Women's Hospital, Birmingham, UK
| | - Joanne C Blair
- Department of Endocrinology, Alder Hey Childrens NHS Foundation Trust, Liverpool, UK
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García F, Rodríguez CA, Palomo ML, Català P, Fernández S, Huerta I, Velasco S, Nieto C. Efficacy, acceptability and tolerability of Zelesse® for the treatment of non-specific vulvovaginitis in paediatric patients: The NINESSE Study. J Int Med Res 2018; 46:3583-3595. [PMID: 29877120 PMCID: PMC6136015 DOI: 10.1177/0300060518775566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the efficacy, tolerability and acceptability of Zelesse®, an intimate hygiene wash solution, in the relief of the symptoms and signs of non-specific vulvovaginitis in paediatric patients. Methods The NINESSE Study was a prospective, observational, multicentre study involving females aged 2-8 years who attended paediatric offices with symptoms suggestive of non-specific vulvovaginitis. They were administered Zelesse® as a single treatment for 15 ± 5 days. Pruritus, burning, dysuria, erythema, leucorrhoea and oedema were evaluated before and after treatment. Results A total of 71 paediatric patients were enrolled in the study (mean ± SD age, 4.5 ± 1.9 years). The most significant effects were observed for pruritus and burning, where 98.4% (62 of 63) and 96.9% (63 of 65) of the patients improved after treatment, respectively. Zelesse® demonstrated a beneficial effect on dysuria, erythema, leucorrhoea and oedema. The effects on the symptoms and signs were observed within the first week of treatment; although 44.9% (31 of 69) of patients experienced improvements after 2-3 days. Zelesse® was well accepted and tolerated by most patients. No serious adverse events were reported. Conclusions Zelesse® was very effective for the relief of the symptoms and signs of non-specific vulvovaginitis, in particular pruritus, burning and erythema, in females aged 2-8 years.
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Affiliation(s)
- Fátima García
- 1 Private Paediatrics Office, Hospital Virgen del Mar, Madrid, Spain
| | | | | | - Pere Català
- 4 Private Paediatrics Office, Centro Médico Medinfant, Barcelona, Spain
| | - Santiago Fernández
- 5 Private Paediatrics Office, Clínica Pediátrica Fernández Cebrián, Ourense, Spain
| | - Ibone Huerta
- 6 Medical Department, ITF Research Pharma S.L.U., Madrid, Spain
| | - Syra Velasco
- 6 Medical Department, ITF Research Pharma S.L.U., Madrid, Spain
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Chen X, Chen L, Zeng W, Zhao X. Haemophilus influenzae vulvovaginitis associated with rhinitis caused by the same clone in a prepubertal girl. J Obstet Gynaecol Res 2018. [PMID: 28621044 DOI: 10.1111/jog.13311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vulvovaginitis caused by upper respiratory flora is generally considered to be the most common gynecological problem in prepubertal girls. To date, however, no direct evidence has been obtained for the underlying mechanism of transmission. This report describes a case of non-capsulate Haemophilus influenzae vulvovaginitis in a 6-year-old girl with a history of foreign bodies (cotton wool) in her vagina. Moreover, this girl had recurrent rhinitis for approximately 3 years. On Pulsed Field Gel Electrophoresis (PFGE) analysis the H. influenzae strain isolated from vaginal secretions and the H. influenzae strain isolated from nasal secretions were derived from the same clone. The patient was successfully treated with appropriate antibiotics. The present case might provide the first direct evidence of the nose-hand-vagina method of transmission.
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Affiliation(s)
- Xiao Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lifeng Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Wenjie Zeng
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Xiaofeng Zhao
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
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Sianou A, Galyfos G, Moragianni D, Baka S. Prevalence of vaginitis in different age groups among females in Greece. J OBSTET GYNAECOL 2017; 37:790-794. [PMID: 28468531 DOI: 10.1080/01443615.2017.1308322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with vaginitis were classified into four groups: Group A (prepubertal under-aged females); Group B (pubertal under-aged females); Group C (reproductive age adult females); Group D (postmenopausal adult females). All vaginal specimens underwent microscopy, amine testing, Gram staining and culturing. Overall, 163 patients were included (33, 14, 81 and 35 patients, respectively). The most common infection was bacterial vaginosis (BV), followed by Ureaplasma infection, aerobic vaginitis (AV) and candidiasis. The most common AV-associated organism was Escherichia coli and the most common BV-associated organism was Gardnerella vaginalis. AV was more frequent in Group A, BV in Group C and Ureaplasma infections in Groups C/D. Decreased lactobacilli concentrations were associated with BV in fertile patients (Groups B-C). Although presentation of vaginitis is similar among females of different age in Greece, type and prevalence of pathogens differ. Normal vaginal flora changes are associated with higher risk of vaginitis in specific age groups. Impact Statement The worldwide incidence of reproductive tract infections has been increasing, with specific pathogens being associated with significant risk of morbidity and complications. However, literature data on the distribution of such infections in different age groups is limited. Therefore, the aim of this study was to provide data on the prevalence and causes of vaginitis in adult and non-adult females of all ages. This study has shown that although presentation of vaginitis is similar among females of different age groups and menstrual status in Greece, type and prevalence of responsible pathogens are different among groups. Changes in normal vaginal flora seem to be associated with higher risk of vaginitis in specific age-groups as well. These findings could contribute in adjusting diagnostic and therapeutic strategies for each age group according to the prevailing pathogens. Further research on antibiotic resistance and treatment outcomes for each age group should be conducted.
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Affiliation(s)
- Argiri Sianou
- a Department of Microbiology , University of Athens Medical School, Areteion Hospital , Athens , Greece
| | - George Galyfos
- a Department of Microbiology , University of Athens Medical School, Areteion Hospital , Athens , Greece
| | - Dimitra Moragianni
- a Department of Microbiology , University of Athens Medical School, Areteion Hospital , Athens , Greece
| | - Stavroula Baka
- a Department of Microbiology , University of Athens Medical School, Areteion Hospital , Athens , Greece
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Randjelovic G, Otasevic S, Mladenovic-Antic S, Mladenovic V, Radovanovic-Velickovic R, Randjelovic M, Bogdanovic D. Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children. Pediatr Int 2017; 59:432-437. [PMID: 27638252 DOI: 10.1111/ped.13169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022]
Abstract
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 cMLSB 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.
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Affiliation(s)
- Gordana Randjelovic
- Faculty of Medicine, University of Nis, Niš, Serbia.,Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | - Suzana Otasevic
- Faculty of Medicine, University of Nis, Niš, Serbia.,Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | | | - Vesna Mladenovic
- Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | | | | | - Dragan Bogdanovic
- Center of Microbiology, Public Health Institute Nis, Niš, Serbia.,Department of Biomedical Sciences, State University of Novi Pazar, Novi Pazar, Serbia
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Clinical presentation, diagnosis and treatment of vulvovaginitis in girls: a current approach and review of the literature. World J Pediatr 2017; 13:101-105. [PMID: 28083751 DOI: 10.1007/s12519-016-0078-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 10/12/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Vulvovaginitis is the most common cause of gynecological complaints in children and young girls. Some of the factors which cause vulvovaginitis include hypoestrogenism, the anatomical proximity of rectum and delicate vulvar skin and vaginal mucosa. DATA SOURCES We made a literature search with Pubmed, Medline and Cochrane database from January 2002 to May 2015 in English language using the key words vulvovaginitis, children, clinical, diagnosis and treatment. RESULTS Vulvovaginitis in girls is usually caused by non-specific factors and hygiene measures, bioyoghurt and avoidance of chemical irritants are generally useful. Weight control if necessary and prevention of voiding dysfunction are effective. Vaginal flora is important in girls and results should be interpreted with clinical features to decide whether an isolated microorganism is part of the normal microflora or is the cause of symptomatic vulvovaginitis. Specific treatment is generally considered in case of a detected pathogen microorganism. Isolation of a sexually transmitted organism requires further investigation. Persistent disease may not always indicate a foreign body but it must be taken into account. Girls and parents are encouraged psychologically in all steps of evaluation, diagnosis and treatment. Probiotics, nanotechnology and petroleum jelly are other important treatment options used in vulvovaginitis. CONCLUSIONS In this review, we present current approach to the presentation and management of vulvovaginitis in childhood. This disorder requires a comprehensive evaluation in all steps of diagnosis, differential diagnosis and treatment.
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Cemek F, Odabaş D, Şenel Ü, Kocaman AT. Personal Hygiene and Vulvovaginitis in Prepubertal Children. J Pediatr Adolesc Gynecol 2016; 29:223-7. [PMID: 26187769 DOI: 10.1016/j.jpag.2015.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 06/12/2015] [Accepted: 07/10/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To 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 MEASURES: This 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. RESULTS The 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%). CONCLUSION Our 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.
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Affiliation(s)
- Fatıma Cemek
- Department of Pediatrics, Basaksehir State Hospital, Istanbul, Turkey.
| | - Dursun Odabaş
- Department of Pediatrics, Konya Training and Research Hospital, Konya, Turkey
| | - Ünal Şenel
- Department of Bioengineering, Faculty of Chemistry and Metallurgy Engineering, Yıldız Technical University, Istanbul, Turkey
| | - Ayşe Tuba Kocaman
- Department of Bioengineering, Faculty of Chemistry and Metallurgy Engineering, Yıldız Technical University, Istanbul, Turkey
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Clinical and microbiologic characteristics of vulvovaginitis in Korean prepubertal girls, 2009-2014: a single center experience. Obstet Gynecol Sci 2016; 59:130-6. [PMID: 27004204 PMCID: PMC4796083 DOI: 10.5468/ogs.2016.59.2.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/25/2015] [Accepted: 10/20/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To update information on the clinical and microbiologic characteristics of pediatric vulvovaginitis in Korean prepubertal girls. METHODS A total of 120 girls (aged 0 to 9 years) with culture-confirmed pediatric vulvovaginitis, diagnosed between 2009 and 2014, were enrolled in the study. The epidemiologic and microbiologic characteristics, and clinical outcomes were assessed. Patients with sexual precocity, as well as those who were referred for suspected sexual abuse, were excluded. RESULTS Girls aged 4 to 6 years were at the highest risk of pediatric vulvovaginitis. Seasonal distribution indicated obvious peaks in summer and winter. Of the 120 subjects, specific pathogens were identified in the genital specimens in only 20 cases (16.7%). Streptococcus pyogenes (n=12, 60%) was the leading cause of specific vulvovaginitis. Haemophilus influenzae was isolated in one patient. No cases presented with enteric pathogens, such as Shigella or Yersinia. A history of recent upper respiratory tract infection, swimming, and bubble bath use was reported in 37.5%, 15.8%, and 10.0% of patients, respectively. Recent upper respiratory tract infection was not significantly correlated with the detection of respiratory pathogens in genital specimens (P>0.05). Of 104 patients who underwent perineal hygienic care, 80 (76.9%) showed improvement of symptoms without antibiotic treatment. Furthermore, the efficacy of hygienic care was not significantly different between patients with or without specific pathogens (P>0.05). CONCLUSION Specific pathogens were only found in 16.7% of pediatric vulvovaginitis cases. Our results indicate an excellent outcome with hygienic care, irrespective of the presence of specific pathogens.
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Hickey RJ, Zhou X, Settles ML, Erb J, Malone K, Hansmann MA, Shew ML, Van Der Pol B, Fortenberry JD, Forney LJ. Vaginal microbiota of adolescent girls prior to the onset of menarche resemble those of reproductive-age women. mBio 2015; 6:e00097-15. [PMID: 25805726 PMCID: PMC4453513 DOI: 10.1128/mbio.00097-15] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/18/2015] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED Puberty is an important developmental stage wherein hormonal shifts mediate the physical and physiological changes that lead to menarche, but until now, the bacterial composition of vaginal microbiota during this period has been poorly characterized. We performed a prospective longitudinal study of perimenarcheal girls to gain insight into the timing and sequence of changes that occur in the vaginal and vulvar microbiota during puberty. The study enrolled 31 healthy, premenarcheal girls between the ages of 10 and 12 years and collected vaginal and vulvar swabs quarterly for up to 3 years. Bacterial composition was characterized by Roche 454 pyrosequencing and classification of regions V1 to V3 of 16S rRNA genes. Contrary to expectations, lactic acid bacteria, primarily Lactobacillus spp., were dominant in the microbiota of most girls well before the onset of menarche in the early to middle stages of puberty. Gardnerella vaginalis was detected at appreciable levels in approximately one-third of subjects, a notable finding considering that this organism is commonly associated with bacterial vaginosis in adults. Vulvar microbiota closely resembled vaginal microbiota but often exhibited additional taxa typically associated with skin microbiota. Our findings suggest that the vaginal microbiota of girls begin to resemble those of adults well before the onset of menarche. IMPORTANCE This study addresses longitudinal changes in vaginal and vulvar microbial communities prior to and immediately following menarche. The research is significant because microbial ecology of the vagina is an integral aspect of health, including resistance to infections. The physiologic changes of puberty and initiation of cyclic menstruation are likely to have profound effects on vaginal microbiota, but almost nothing is known about changes that normally occur during this time. Our understanding has been especially hampered by the lack of thorough characterization of microbial communities using techniques that do not rely on the cultivation of fastidious bacteria, as well as a dearth of studies on girls in the early to middle stages of puberty. This study improves our understanding of the normal development of vaginal microbiota during puberty and onset of menarche and may better inform clinical approaches to vulvovaginal care of adolescent girls.
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Affiliation(s)
| | - Xia Zhou
- Department of Biological Sciences, University of Idaho, Moscow, Idaho, USA
| | | | - Julie Erb
- FemCare Division, Procter & Gamble, Cincinnati, Ohio, USA
| | - Kristin Malone
- FemCare Division, Procter & Gamble, Cincinnati, Ohio, USA
| | | | - Marcia L Shew
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Barbara Van Der Pol
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Hertweck P, Yoost J. Common problems in pediatric and adolescent gynecology. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Úlcera vulvar aguda o de Lipschütz: comparación de 2 casos clínicos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2012.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tartaglia E, Giugliano B, Ucciferri C, Giannattasio A, Giuliano P, Iannaccone VL, Pisani F, Mastrantonio P. Vulvo-vaginitis in prepubertal girls: new ways of administering old drugs. J Pediatr Adolesc Gynecol 2013; 26:277-80. [PMID: 24012128 DOI: 10.1016/j.jpag.2013.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/02/2013] [Accepted: 05/10/2013] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To evaluate the effectiveness and safety of local vs systemic antibiotic treatment in the management of recurrent vulvovaginitis in children. DESIGN Randomized treatment and follow-up of 90 cases of persistent vulvovaginitis. SETTING The Department of Medicine and Health Sciences, Institute of Gynecology and Obstetrics, University of Molise, Italy. METHODS Between 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. RESULTS Bacterial 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). CONCLUSION Topical 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.
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Affiliation(s)
- Edoardo Tartaglia
- University of Molise, Department of Medicine and Health Sciences, Campobasso, Italy.
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Microbiological aspects of vulvovaginitis in prepubertal girls. Eur J Pediatr 2012; 171:1203-8. [PMID: 22383074 DOI: 10.1007/s00431-012-1705-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED 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.
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Affiliation(s)
- Alison R Gardner
- Wake Forest University School of Medicine, Winston-Salem, NC 27157-1089, USA
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Matytsina LA, Greydanus DE, Gurkin YA. Vaginal microbiocoenosis and cytology of prepubertal and adolescent girls: their role in health and disease. World J Pediatr 2010; 6:32-7. [PMID: 20143208 DOI: 10.1007/s12519-010-0003-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 03/04/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Clinicians and investigators often do not appreciate the importance of vaginal microbiocoenosis and vaginal cytology in the health of prepubertal and adolescent girls. DATA SOURCES Based on recent publications in human medicine and our own experience with vaginal cytology and microbiology in children and adolescent girls, we review the principles of vaginal microbiocoenosis and cytology and their roles in disease prevention in prepubertal and adolescent girls. RESULTS The main role of vaginal microbiocoenosis and cytology in diagnosing as well as developing vulvovaginitis is demonstrated. Clinicians can identify states of vaginal health and disease by important well-known diagnostic tools, including vaginal cytology. Lactobacilli are infrequently observed in the prepubertal girls, but become more abundant in adolescent girls. Three basic types of vaginal smears are presented in addition to a classification of inflammatory urogenital diseases. Management of common types of vulvovaginitis is also considered. CONCLUSIONS This essential shift in vaginal biocoenosis is important to prevent the growth of potentially pathogenic flora in the vagina. The detection of vaginal microbiocoenosis problems and recognition of changing cytology in vaginal development can provide helpful clues to identifying and preventing vaginal diseases in this pediatric population.
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Affiliation(s)
- Lyubov A Matytsina
- Obstetrics, Gynecology, Perinatology and Pediatric & Adolescent Gynecology, Donetsk Medical University, Donetsk, Ukraine.
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Heymann WR. Streptococcal vulvovaginitis. J Am Acad Dermatol 2009; 61:94-5. [DOI: 10.1016/j.jaad.2008.11.895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 11/20/2008] [Accepted: 11/24/2008] [Indexed: 11/24/2022]
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Vilà de Muga M, Pineda Solas V, Loverdos Eseverri I, Pérez Sánchez J, San Vicente Vela B, Argemí Renom S. Vaginitis recurrente y peritonitis por Streptococcus pneumoniae en niña prepuberal. An Pediatr (Barc) 2008; 68:627-8. [DOI: 10.1157/13123301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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