Childhood vulvovaginitis and vaginal discharge in general practice

OBJECTIVE.: This study aims to examine the aetiology, clinical featuresand response to treatment of childhood vulvovaginitis in generalpractice. METHOD.: A longitudinal survey of consecutive premenarchal patients presentingwith vulvovaginitis and/or vaginal discharge in the course ofnormal consultations with a general practitioner was conductedin a a semi-rural, group general practice with 11 000 patientsin Plymouth, UK. Forty-two premenarchal girls with vaginal inflammationor discharge were surveyed, with main outcome measures beingclinical evaluation, microbiological assessment of urine andvaginal swabs, and patients' and parents' assessments of resolutionand relapse of symptoms. RESULTS.: Non-specific vulvovaginitis with mixed bacterial flora, associatedwith poor hygiene and atrophic vaginal mucosa, was the commonestcause; specific bacteria were found in 10 out of 42 cases, includingsix of Streptococcus pyogenes. No candida was isolated. Treatmentwith topical oestrogen cream was effective only with mixed infection,oral antibiotics were effective in both mixed and single organisms.No evidence of sexual abuse nor foreign body was found. CONCLUSIONS.: Childhood vulvovaginitis is not uncommon in general practice,is usually associated with mixed growth of faecal organisms,and is seldom due to serious causes such as sexual abuse orforeign body. Keywords. Vulvovaginitis, vaginal discharge, children, general practice.