Streptococcus pyogenes pharyngeal colonization resulting in recurrent, prepubertal vulvovaginitis

Area of Science:

• Pediatric Gynecology
• Infectious Diseases
• Microbiology

Background:

• Recurrent vulvovaginitis in prepubertal children presents diagnostic challenges.
• Potential causes include skin conditions, foreign bodies, sexual abuse, and allergies.
• This case highlights Streptococcus pyogenes vulvovaginitis secondary to pharyngeal colonization.

Observation:

• A 4-year-old experienced recurrent, culture-proven Streptococcus pyogenes vulvovaginitis.
• Symptoms resolved with penicillin but recurred upon cessation of treatment.
• Both the patient and her mother had pharyngeal Group A Streptococcus colonization.

Findings:

• Normal genital tract anatomy was confirmed via physical examination, ultrasound, and vaginoscopy.
• Combined amoxicillin and rifampin therapy for pharyngeal decolonization led to symptom resolution.
• Post-treatment cultures were negative for Group A Streptococcus in both mother and child.

Implications:

• This case illustrates a specific cause of recurrent vaginitis: re-inoculation from pharyngeal carriage.
• Asymptomatic pharyngeal colonization can lead to recurrent vulvovaginitis despite initial penicillin treatment.
• Considering pharyngeal re-infection is crucial for managing recurrent Group A Streptococcus vulvovaginitis.