Clinical and Microbiological Findings of Vulvovaginitis in Prepubertal Girls

Jarienė, Kristina; Drejerienė, Eglė; Jaras, Algirdas; Kabašinskienė, Aistė; Čelkienė, Ieva; Urbonavičienė, Neringa

doi:10.1016/j.jpag.2019.08.009

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…The cases that are still reported, even in the vaccinated populations, are probably caused mostly by non-encapsulated or untypeable strains of H. influenzae . The low rate detected in our study may be attributed to the implementation of the vaccine from 1995 in Greece, and this result is in agreement with reports from different countries where vaccination is available [ 13 , 19 , 20 ]. In contrast, a recent report identified H. influenzae as the second most common pathogen in preschool-aged girls with a prevalence of 27.2% while McGreal and Wood reported it as the third most common pathogen with a prevalence of 10% in prepubertal girls [ 12 , 21 ].…”

Section: Discussionsupporting

confidence: 93%

“…It is a common pathogen for the upper respiratory tract, and thus, children who are colonized with S. pyogenes are at increased risk of streptococcal vulvovaginitis since this pathogen can be easily transferred in the genital area [ 23 ]. Although not the commonest pathogen in our study population, the prevalence of S. pyogenes was similar with recent reports [ 12 , 20 ].…”

Section: Discussionsupporting

confidence: 92%

“…Streptococcus pyogenes (group A beta-haemolytic Streptococcus ) is an important human pathogen responsible for different infections in the human body. Often has been reported as the most prevalent or one of the commonest causes of vulvovaginitis in girls [ 8 , 12 , 13 , 19 , 20 , 22 ]. It is a common pathogen for the upper respiratory tract, and thus, children who are colonized with S. pyogenes are at increased risk of streptococcal vulvovaginitis since this pathogen can be easily transferred in the genital area [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Microbiological findings in prepubertal and pubertal girls with vulvovaginitis

et al. 2022

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Vulvovaginitis is a common and challenging gynaecological problem in prepubertal and pubertal girls. Such an infection, owing to a wide range of aetiologies, if not responding to hygienic measures, needs further investigation through vaginal cultures, since treatment should be tailored accordingly. This study aimed to investigate the pathogens isolated in prepubertal and pubertal girls with signs and symptoms of vulvovaginitis. A total of 2314 symptomatic girls, 1094 prepubertal and 1220 pubertal, aged 2 to 16 years, were included. Vaginal samples were inoculated on specific culture plates followed by incubation in aerobic, anaerobic or CO2 atmosphere at 37 °C for 24 or 48 h, as appropriate. The identification of the isolated pathogens was carried out using Gram stain, conventional methods and the automated system VITEK 2 (BioMerieux, Marcy l’Etoile, France). Positive cultures were obtained from 587 (53.7%) of prepubertal girls and 926 (75.9%) of pubertal girls. A total of 613 and 984 pathogens were detected in prepubertal and pubertal subjects, respectively. Isolated bacteria included 40.1% and 22.8% Gram-positive cocci, 35.6% and 24.8% Gram-negative rods in the prepubertal and pubertal groups, respectively, with faecal pathogens being the most prevalent. Bacterial vaginosis was diagnosed in 22.8% of prepubertal and 37.9% of pubertal girls. Candida species were isolated mostly in the pubertal girls (14.5%).Conclusion: Culture results should be evaluated with caution in children with vulvovaginitis. In the prepubertal girls, the most common isolated pathogens were opportunistic bacteria of faecal origin while girls in late puberty were more susceptible to bacterial vaginosis and vulvovaginal candidiasis. What is Known:• Vulvovaginitis is the most frequent and challenging reason for referral to paediatric and adolescent gynaecology services.• Microbiological examination can prove to be a significant tool to help diagnosis although results should be evaluated with caution in children. What is New:• Significantly more positive vaginal cultures and pathogens were recorded in symptomatic pubertal girls compared to prepubertal children.• The prevalence of bacterial vaginosis was increased in both prepubertal and pubertal girls with vulvovaginitis although significantly more in girls at puberty.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Microbiological findings in prepubertal and pubertal girls with vulvovaginitis

et al. 2022

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“…Shigella is a rare cause of vulvovaginitis; therefore, it is not routinely tested for on cultures and must be ordered specifically. The most common vulvovaginitis bacteria tested for in children include S. pyogenes , H. influenzae , Escherichia coli , Candida albicans and Neisseria gonorrhoeae 1 3 13 14 . Shigella may go undetected in routine laboratory assays due to limited viability outside the human body and improper culturing techniques.…”

Section: Discussionmentioning

confidence: 99%

Vaginal bleeding in prepubertal females: a case ofShigellavaginitis and review of literature

Gershman

Simms-Cendan

2022

BMJ Case Rep

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Shigella vulvovaginitis is an uncommon aetiology of prepubertal vaginal bleeding that should be considered in the differential diagnosis, especially in patients who have travelled to developing countries. A young girl presented with prepubertal vaginal bleeding, pelvic pain, occasional dysuria and no gastrointestinal symptoms. After a year-long extensive workup, including vaginoscopy and biopsy, genital culture and Gram stain revealed vulvovaginitis due to Shigella flexneri. After review of bacterial sensitivity, the patient was given a 30-day course of sulfamethoxazole-trimethoprim. The patient returned to the clinic 1 month later with no signs of vaginal bleeding, discharge or pelvic pain. This case prompted review of the indicated evaluation and differential diagnosis of prepubertal vaginal bleeding, including infectious aetiologies such as Shigella vulvovaginitis with the authors’ goal to expedite diagnosis and treatment in paediatric patients.

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“…Prevotella , not Lactobacillus , was the predominant vaginal species in healthy prepubertal girls, although there is evidence that several species of Prevotella found in the vagina are associated with bacterial vaginosis (BV) [ 10 ]. Compared with the HVS group, the relative abundance of Granulicatella , Streptococcus , and Haemophilus , which have been found to be closely related to vaginal infection, was enriched in the VVS group [ 11 , 12 ]. It has been reported that fecal flora is a significant cause of vulvovaginitis in prepubertal girls.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the vaginal microbiomes in prepubertal girls with and without vulvovaginitis

Liu

Pan

et al. 2021

Eur J Clin Microbiol Infect Dis

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The present study focused on the characteristics of the vaginal microbiomes in prepubertal girls with and without vulvovaginitis. We collected 24 vaginal samples and 16 fecal samples from 10 girls aged 3–9 years with vulvovaginitis and 16 healthy girls of the same age. The samples were divided into three groups: fecal swabs from healthy controls (HF), vaginal swabs from healthy controls (HVS), and vaginal swabs from girls with vulvovaginitis (VVS). Sequencing of the V3–V4 region of the 16S rDNA gene was performed with the NovaSeq PE250 platform to reveal the vaginal microbial community structure in healthy prepubertal girls and vulvovaginitis-associated microbiota. The intestinal microbiomes of healthy children were also analyzed for comparison. This study revealed that the healthy vaginal tract in prepubertal girls was dominated by Prevotella, Porphyromonas, Ezakiella, and Peptoniphilus species, with a high diversity of microbiota. The vulvovaginitis-associated microbiota were dominated by Streptococcus, Prevotella, Haemophilus, and Granulicatella, with lower diversity than that in healthy girls. Furthermore, the compositions of the vaginal and intestinal microbiomes were completely different. ANOSIM, MRPP, Adonis, and AMOVA were used to analyze the beta diversity, and the results showed that there were significant differences in the microbial communities among the three groups. Lactobacillus deficiency and high bacterial diversity were characteristics of the vaginal microbiome in healthy prepubertal girls; this is inconsistent with that in reproductive-age women. The vulvovaginitis-associated vaginal microbiota differed dramatically from normal microbiota, and the main causative agents were not fecal in origin.

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Clinical and Microbiological Findings of Vulvovaginitis in Prepubertal Girls

Cited by 12 publications

References 15 publications

Microbiological findings in prepubertal and pubertal girls with vulvovaginitis

Microbiological findings in prepubertal and pubertal girls with vulvovaginitis

Vaginal bleeding in prepubertal females: a case ofShigellavaginitis and review of literature

Characteristics of the vaginal microbiomes in prepubertal girls with and without vulvovaginitis

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