Vulvovaginitis in Premenarcheal Girls: Clinical Features and Diagnostic Evaluation

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Abstract
Fifty-four premenarcheal patients (median age 5.8 yr) with symptoms or signs of vulvovaginitis were studied and the results of cultures of vaginal secretions were compared with those from an age-matched control group. Vaginal discharge was found on examination in 24 of 42 patients with a complaint of discharge and in 2 of 12 patients without a complaint of discharge. Convincing evidence of bacterial or monilial infection was found in 14 of the 26 patients with discharge on examination but in none of the 28 patients without discharge (P < 0.001). In the latter group pinworm infestation was present in 1 patient. Moniliasis occurred exclusively in girls who were pubertal (P < 0.001). Four patients were found to have gonorrhea. No patient appeared to have symptoms or signs caused by Bacteroides sp., Chlamydia trachomatis, viruses or Trichomonas vaginalis. Noninfectious causes were identified in 4 patients with and 13 without discharge (P < 0.025); the most common cause was poor hygiene, implicated in 6 patients. Bubble bath use was implicated in only 1 patient. In 22 patients, no specific cause could be identified. All patients with poor hygiene as the only cause and most with no demonstrable etiology recovered after being advised to institute improved perineal hygiene. Patients with vaginal discharge are likely to have specific infections and therefore cultures should be taken, in particular for Neisseria gonorrhoeae. Genital pruritus in prepubertal girls has little or not etiologic specificity but in pubertal girls with vaginal discharge it suggests the presence of monilial vaginitis.