Recurrent Group A Streptococcal Vulvovaginitis in Adult Women: Family Epidemiology

Abstract

Group A beta-hemolytic streptococcal (GAS) vulvovaginitis has been reported in prepubertal girls. In adult women, a vaginal carrier state has been described, but vulvovaginitis is rarely reported. We describe 2 cases of recurrent GAS vulvovaginitis in women whose husbands were gastrointestinal carriers of GAS. Characterization of the isolated strains demonstrated that identical emm types of GAS were shared by partners. Treatment of both partners resulted in resolution of vaginitis. On the basis of negative vaginal culture results obtained after treatment of each individual episode of vaginitis, we believe that the female patients were reinfected as a result of exposure to their husbands, with shedding likely to have occurred in bed. These cases reiterate the necessity for adequate screening of the patient's family and contacts in cases of recurrent GAS infection by culturing all potential areas of GAS carriage.

Induction of a quorum sensing pathway by environmental signals enhances group A streptococcal resistance to lysozyme

“…However, up to ∼ 15% of healthy individuals, depending on age, are asymptomatically colonized by this bacterium (Hoffmann, 1985;Durmaz et al, 2003;Martin et al, 2004;Shaikh et al, 2010). Though the oropharynx is thought to be the primary site of colonization, GAS may also be present in the gastrointestinal and genitourinary tracts, underscoring the importance of its ability to adapt to diverse and dynamic environments (McKee et al, 1966;Berkelman et al, 1982;Mogielnicki et al, 2000;Sobel et al, 2007;Dei et al, 2010;Verstraelen et al, 2011). The full complement of regulatory factors involved in its adaptation to different ecological niches, and the conditions that favor carriage over pathogenesis, and vice versa, are not completely understood.…”

Longitudinal analysis of the vaginal microflora in pregnancy suggests that L. crispatus promotes the stability of the normal vaginal microflora and that L. gasseri and/or L. iners are more conducive to the occurrence of abnormal vaginal microflora

“…Despite their intrinsic antimicrobial potential however, vaginal lactobacilli fail to retain dominance in a considerable number of women, resulting in overgrowth of the vaginal epithelium by other bacteria, as observed, most typically, with anaerobic polymicrobial overgrowth in bacterial vaginosis [1], or less commonly, with overgrowth by streptococci, including group A [4] and group B streptococci [5,6], by bifidobacteria [7,8], or by coliforms such as E. coli [5,6,9]. …”

Approach to the diagnosis and treatment of vulvar pain

“…The diagnosis is made by culture. Treatment is with Penicillin VK 500 mg four times daily for 10 to 14 days or clindamycin cream 2% per vagina for 7 to 10 days (34,37). The question as to whether group B streptococcus is a pathogen in the vagina is controversial; some clinicians believe that vaginitis is improved with antibiotic treatment.…”