Prepubertal vaginitis

- DDx includes: local irritation (e.g. bubblebath), foreign body, or trauma including sexual abuse.

- If vaginal discharge, do:

  • careful history and physical to rule out suspected abuse
  • swabs of vagina for:
    • Gram stain
    • C&S
    • Gonorrhea NAAT and culture
    • Chlamydia NAAT
    • wet mount
    • KOH/whiff test.

- If a vaginal swab will be traumatic for the girl, instead send urine for gonorrhea and chlamydia NAAT.

- Follow-up NAAT recommended for test of cure:

  • Gonorrhea - at 3-4 weeks
  • Chlamydia - at 3-4 weeks

- If bloody discharge, consult paediatrics or gynecology to rule out foreign body or tumor.

- Do not do speculum exam in prepubertal children.

- In cases of suspected sexual abuse, all specimens should be submitted with chain of custody documentation.

Usual Pathogens
Non sexually transmitted infections:

Group A Streptococci
Shigella spp
Candida spp

Sexually transmitted infections (age at which nonvertical transmission becomes most likely):

Gonorrhea (> 1 month)
Trichomoniasis (> 6 months)
Chlamydia (> 6 months)
HSV (> 3 months)


Treat according to cause