Vulvovaginitis
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
Other
Sexually transmitted infections (age at which nonvertical transmission becomes most likely):
Gonorrhea (> 1 month)
Trichomoniasis (> 6 months)
Chlamydia (> 6 months)
HSV (> 3 months)