Scribd Logo
Upload

Welcome to Scribd!

  • 14 views

    50 Years Ago in The Journal of Pediatrics

    Uploaded by

    rischa
    The document discusses a study on vulvovaginitis in premenarcheal girls from 50 years ago. The study assessed 50 premenarcheal patients with vulvovaginitis and 21 control subjects, obtaining bacterial, viral, parasitic, and fungal studies. Only 33 patients yielded a specific diagnosis, with Escherichia coli most commonly isolated. Viruses were rarely found. Common forms of vulvitis were also reported as toxic-allergic. The characteristics of discharge were historically used to suggest specific etiologies but are now considered nonspecific.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    50 Years Ago in The Journal of Pediatrics

    Uploaded by

    rischa
    14 views1 page
    The document discusses a study on vulvovaginitis in premenarcheal girls from 50 years ago. The study assessed 50 premenarcheal patients with vulvovaginitis and 21 control subjects, obtaining bacterial, viral, parasitic, and fungal studies. Only 33 patients yielded a specific diagnosis, with Escherichia coli most commonly isolated. Viruses were rarely found. Common forms of vulvitis were also reported as toxic-allergic. The characteristics of discharge were historically used to suggest specific etiologies but are now considered nonspecific.

    Original Description:

    Ya

    Original Title

    Vulvovaginitisinthepremenarchealchild

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses a study on vulvovaginitis in premenarcheal girls from 50 years ago. The study assessed 50 premenarcheal patients with vulvovaginitis and 21 control subjects, obtaining bacterial, viral, parasitic, and fungal studies. Only 33 patients yielded a specific diagnosis, with Escherichia coli most commonly isolated. Viruses were rarely found. Common forms of vulvitis were also reported as toxic-allergic. The characteristics of discharge were historically used to suggest specific etiologies but are now considered nonspecific.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views1 page

    50 Years Ago in The Journal of Pediatrics

    Uploaded by

    rischa
    The document discusses a study on vulvovaginitis in premenarcheal girls from 50 years ago. The study assessed 50 premenarcheal patients with vulvovaginitis and 21 control subjects, obtaining bacterial, viral, parasitic, and fungal studies. Only 33 patients yielded a specific diagnosis, with Escherichia coli most commonly isolated. Viruses were rarely found. Common forms of vulvitis were also reported as toxic-allergic. The characteristics of discharge were historically used to suggest specific etiologies but are now considered nonspecific.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    March 2019 ORIGINAL ARTICLES

    19. Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster ran- 5 years in 20,536 high-risk individuals: a randomised controlled trial. Lancet
    domized trials. Contemp Clin Trials 2007;28:182-91. 2011;378:2013-20.
    20. Zoungas S, Chalmers J, Neal B, Billot L, Li Q, Hirakawa Y, et al. Follow- 22. Wiles NJ, Thomas L, Turner N, Garfield K, Kounali D, Campbell J, et al.
    up of blood-pressure lowering and glucose control in type 2 diabetes. N Long-term effectiveness and cost-effectiveness of cognitive behavioural
    Engl J Med 2014;371:1392-406. therapy as an adjunct to pharmacotherapy for treatment-resistant de-
    21. Heart Protection Study Collaborative Group. Effects on 11-year mortal- pression in primary care: follow-up of the CoBalT randomised con-
    ity and morbidity of lowering LDL cholesterol with simvastatin for about trolled trial. Lancet Psychiatry 2016;3:137-44.

    50 Years Ago in The Journal of Pediatrics


    Vulvovaginitis in the Premenarcheal Child
    Heller RH, Joseph JM, Davis HJ. J Pediatr 1969;74:370-7

    V aginal symptoms in premenarchal girls are challenging complaints owing to the wide range of etiologies and diverse
    clinical manifestations. In the late 1960s, Heller et al described the findings of 50 premenarcheal patients as-
    sessed for vulvovaginitis and 21 control subjects at the Baltimore City Hospitals. Bacterial, viral, parasitic, and fungal
    studies were obtained from urine, vaginal, and rectal specimens; only 33 patients yielded a specific diagnosis. Even though
    Escherichia coli led the list of bacterial cultures, it was isolated from both groups, followed by Staphylococcus epidermidis
    (formerly called Staphylococcus albus), diphteroids, Klebsiella-Aerobacter, and Streptococcus. Although monilial vagini-
    tis was diagnosed in only 3 infants aged <1 year, with 2 of their mothers requiring antifungal treatment, further work
    has reported vaginal yeast infections predominantly in prepubescents.1 Viruses, although rarely found, include herpes
    simplex virus, adenovirus, and ECHO viruses, the latter found in the vagina and rectum. Pinworm and trichomonia-
    sis constitute the only parasites reported. Interestingly, common forms of vulvitis have been reported as toxic-allergic.
    Historically, the characteristics of the exudate had prompted clinicians to think of specific aetiologies. For instance,
    yellow-pitch discharge has been associated with Trichomonas vaginalis, curd-like exudate suggests candidal infection,
    and green mucopurulent secretion has been linked to Neisseria gonorrhoeae and Chlamydia trachomatis.2 Nowadays
    these findings are considered nonspecific. Vulvovaginitis in premenarcheal girls can be caused by a hypoestrogenic hor-
    monal milieu, poor hygiene, bubble baths, or tight clothing; for these reasons, medical therapy is seldom necessary
    unless a specific pathogen is identified. Clinical history, vaginal smear, and Gram stain are still sufficient for establish-
    ing a presumptive diagnosis. Although purulent vaginal discharge is highly suggestive of a bacterial pathogen, and empiric
    b-lactam therapy usually achieves clinical improvement, antibiotic therapy should always be addressed according to
    culture susceptibility.3

    Sara E. Ortega Alonzo, MD


    Division of Pediatrics
    School of Medicine and Health Sciences
    Tecnologico de Monterrey
    Monterrey, Mexico

    References

    1. Paradise JE, Campos JM, Friedman HM, Frishmuth G. Vulvovaginitis in premenarcheal girls: clinical features and diagnostic evaluation. Pedi-
    atrics. 1982;70:193-8.
    2. Vandeven A, Emans SJ. Vulvovaginitis in the child and adolescent. Pediatr Rev. 1993;14:141-7.
    3. Beyitler I, Kavukcu S. Clinical presentation, diagnosis and treatment of vulvovaginitis in girls: a current approach and review of the literature.
    World J Pediatr. 2017;13:101-5.

    Post-Trial Sustainability and Scalability of the Benefits of a Medical Home for High-Risk 239
    Children with Medical Complexity

    You might also like