Chapter 102: Vaginitis

High-Yield Facts

• Vulvovaginitis is the most common gynecological disorder in childhood; its causes include physical and chemical irritants and a variety of infectious agents.

• Group A β-hemolytic Streptococcus and Haemophilus influenzae can be self-inoculated from nose and mouth to the vulvar region.

• Candidal vaginitis is rare in prepubertal children and should raise suspicion of diabetes mellitus or depressed immune function.

• Enterobius vermicularis (pinworms) can be a source of irritant vaginitis.

Vulvovaginitis

Vulvovaginitis, or inflammation of the vulva and vagina, is the most common gynecological problem in prepubertal girls.^1,2 Symptoms may include vaginal discharge, redness, soreness, itching, or dysuria.² Vulvovaginal symptoms may be caused by nonspecific irritants, specific infections, trauma, or dermatologic conditions (Table 102-1).³ Contributing factors for prepubertal girls are poor hygiene, lack of estrogenization, proximity of vagina to anus, and lack of labial fat pads or pubic hair.^1,2

Evaluation should include a full history, including symptoms (soreness, itching, burning, dysuria, odor, discharge), location, duration, prior treatments, hygiene habits, voiding habits, physical activities, and the potential for sexual abuse (sexual abuse is covered in Chapter 143 and a comprehensive discussion of sexually transmitted infections is covered in Chapter 88).¹ Evaluation should also include an external genital examination, and a vaginal culture should be obtained if significant vaginal discharge is present.⁴

Nonspecific Vulvovaginitis

Nonspecific vulvovaginitis accounts for 25% to 75% of the cases of vulvovaginitis in prepubertal girls.^5,6 The pathogenesis may be associated with an alteration of vaginal flora with an overgrowth of fecal aerobic bacteria or an overpopulation of anaerobic bacteria found in vaginal flora.⁴ Vaginal culture from girls with vulvovaginitis typically grows organisms considered to be normal flora such as diphtheroids, enterococci, and lactobacilli.⁴ The presence of Escherichia coli is also often found on vaginal culture, which suggests contamination with bowel flora.¹

Management of nonspecific vulvovaginitis includes proper hygiene and avoidance of vulvar irritants (Table 102-2).³ If symptoms persist for longer than 2 to 3 weeks despite these measures, a trial of oral antibiotics, such as amoxicillin, or amoxicillin/clavulanic acid ...