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Vulvovaginitis: causes and management
1Accident and Emergency Department, Royal Liverpool Children's Hospital, Alder Hey.
Insights
Poor hygiene and threadworms are the main causes of vulvovaginitis in girls. Prompt hygiene improvements and parasite treatment effectively resolved symptoms, with urine cultures recommended before antibiotics.
Area of Science:
- Pediatric Gynecology
- Infectious Diseases
Background:
- Vulvovaginitis is a common condition in pediatric patients.
- Identifying the causes is crucial for effective treatment.
Purpose of the Study:
- To investigate the clinical patterns and causes of vulvovaginitis in girls.
- To evaluate treatment outcomes and provide management recommendations.
Main Methods:
- Prospective study of 200 girls with vulvovaginitis over 33 months.
- Clinical assessment, hygiene evaluation, and diagnostic tests (urine culture).
Main Results:
- Poor hygiene and enterobiasis (threadworms) were the primary causes.
- Urinary symptoms were common, but significant bacteriuria was infrequent.
- No sexually transmitted infections were identified.
Conclusions:
- Simple hygiene measures and threadworm treatment are effective.
- Antibiotic use for urinary symptoms should be guided by urine culture results.
- Persistent cases warrant consideration of sexual abuse and dermatological consultation.
Abstract:
Over a period of 33 months in a paediatric accident and emergency department, the clinical pattern and possible causes of vulvovaginitis were studied prospectively in 200 girls presenting with genital discharge, irritation, pain, or redness. The major causes were poor hygiene and threadworms. The suspicion of sexual abuse arose in a few girls but no organisms of sexually transmitted disease were found. Urinary symptoms were common but only 20 patients had a significant bacteriuria and 40 had sterile pyuria. Specific skin problems occurred in 28 cases. Simple measures to improve hygiene and treatment of threadworms gave effective relief. Genital irritation caused urinary symptoms with no clinical evidence of infection, and it is advised that antibiotic treatment should await urine culture. Specific skin problems require help from a dermatologist. The possibility of sexual abuse must be considered especially if the vulvovaginitis is persistent or recurrent after adequate treatment.