PEDIATRIC UROLOGY

Vulvovaginitis in prepubertal girls
Stricker T, Navratil F, Sennhauser FH
University Chidren’s Hospital, Zurich, Switzerland
Arch Dis Child. 2003; 88: 324-6

• This retrospective study evaluated the clinical features and findings in bacterial cultures and in microscopic examination of vaginal secretions in 80 prepubertal girls, aged 2-12 years, with vulvovaginitis. Vaginal secretions were obtained directly from the vagina with a sterile catheter carefully inserted into the vagina. Pathogenic bacteria were isolated in 36% of cases. In 59% of these cases the isolated pathogen was group A beta-haemolytic streptococcus. Candida was not found in any of the patients. The finding of leucocytes in vaginal secretions as an indicator for growth of pathogenic bacteria had a sensitivity of 83% and a specificity of 59%. Antimicrobial treatment should therefore be based on bacteriological findings of vaginal secretions and not on the presence of leucocytes alone.
  
• Editorial Comment
  This study evaluates retrospectively the clinical features and culture results in 80 prepubertal girls referred to a pediatric gynecology clinic. Nearly all had vaginal discharge and many had itching and redness as well. Cultures revealed pathogenic bacteria in 29 of the 80, Group A, beta-hemolytic streptococcus being the most common (41% of these patients had a recent history of sore throat). With blood cells (WBCs) were present in the secretions in 24/29 patients with pathogenic organisms and 21/51 of those without.
  This study provides guidance in the management of vulvovaginitis in girls. In particular, in the absence of WBCs, it is unlikely that pathogenic bacteria are present. Furthermore, Group A streptococcus is the most common organism. However the study has several important flaws. First and foremost there are no controls. What percentage of normal girls have WBCs or streptococcus in their vaginal secretions? Also, no cultures were done for Chlamydia, gonorrhea or Trichomonas. Despite the fact that none of these children had a history of sexual abuse, this is an unfortunate error.

Dr. Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA