Background: The aim of this study was to evaluate clinical findings, microscopic examination and culture of vaginal secretions, and response to treatment in prepubertal girls with vulvovaginitis.
Methods: We studied prospectively over a period of about 6 years in a clinic for pediatric kidney and urinary tract diseases, 171 girls aged 2.5 -8 years with urogenital symptoms.
Findings: Dysuria, erythema, itching, soreness, and vaginal discharge were frequently observed genital symptoms and signs. Pathogenic bacteria were isolated in 27% of cases,
Streptococcus pyogenes
being a common agent. Nonpathogenic enteric flora was isolated in about 43%. There was no growth of bacteria in 30%. Poor hygiene was an associated factor in those with nonpathogenic positive culture (p = 0.001). Purulent vaginal discharge occurred more in cases with vulvovaginal pathogenic infection than in those with negative culture, and this difference was statistically significant (P<0.001). Also there was significant difference in WBC count in vaginal smears of patients with pathogenic bacteria and of those who had no growth of pathogens (p<0.001). Candida and sexually transmitted agents were not found in any of the girls. Labial fusion was not an uncommon abnormality. Simple measures to improve hygiene and use of local estrogen were effective in the patients with nonpathogenic and nonspecific etiology.
Conclusion: Physical examination of genital area should be done in all girls with genitourinary symptoms. Antibiotic should be prescribed based on bacteriologic culture of vaginal secretion. Appropriate hygienic practices and local estrogen application is the most effective therapy in children with noninfectious vulvovaginitis.
