Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract
- Dr Jaquiery.
- Accepted 15 February 1999
AIM To clarify the contribution of clinical and environmental factors and infection to the aetiology of vulvovaginitis in premenarchal girls, and to determine clinical indicators of an infectious cause.
DESIGN It was necessary first to define normal vaginal flora. Cases were 50 premenarchal girls > 2 years old with symptoms of vulvovaginitis; 50 controls were recruited from girls in the same age group undergoing minor or elective surgery.
RESULTS Interview questionnaire showed no difference between cases and controls in regards to hygiene practices, exposure to specific irritants, or history of possible sexual abuse. Normal vaginal flora was similar to that described in previous studies, with the exception of organisms likely to be associated with sexual activity. 80% of cases had no evidence of an infectious cause. In the 10 cases in whom an infectious cause was found, there was significantly more visible discharge and distinct redness of the genital area on examination compared with other cases.
CONCLUSIONS The findings suggest that vulvovaginitis in this age group is not usually infectious or necessarily related to poor hygiene, specific irritants or sexual abuse, although any of these can present with genital irritation. The possibility of sexual abuse should always be considered when a child presents with genital symptoms, but our data indicate it is not a common contributing factor. Infection is generally associated with vaginal discharge and moderate or severe inflammation.
In a large majority of cases of premenarchal vulvovaginitis, no infectious cause can be identified
Cases with a demonstrable infectious cause tend to have more visible discharge and distinct redness of the genital area
Although poor hygiene, specific irritants (for example, bubble bath), and sexual abuse can all present with genital irritation, this series suggests that these factors do not contribute in most cases
Antibiotics and antifungal creams should be used only if the relevant pathogen is identified. Initial treatment should be simple and symptomatic—for example, salt or vinegar baths