European Journal of Pediatrics

, Volume 171, Issue 8, pp 1203–1208 | Cite as

Microbiological aspects of vulvovaginitis in prepubertal girls

  • Gordana RanđelovićEmail author
  • Vesna Mladenović
  • Ljiljana Ristić
  • Suzana Otašević
  • Sofija Branković
  • Snežana Mladenović-Antić
  • Milena Bogdanović
  • Dragan Bogdanović
Original Article


This study aimed to establish the vaginal introitus microbial flora in girls with and without symptoms of vulvovaginitis, and to present the distribution of isolated microorganisms by age groups in girls with vulvovaginitis. We enrolled 500 girls with vulvovaginitis symptoms, aged 2–12 years, referred by their pediatricians for microbiological examination of the vaginal introitus swabs, and 30 age-matched asymptomatic girls. Similar microbial flora was isolated in both groups, but the symptomatic girls had significantly more common positive microbiological findings compared to controls (p < 0.001). In symptomatic girls, the following pathogenic bacteria were isolated: Streptococcus pyogenes (4.2%), Haemophilus influenzae (0.4%), and Staphylococcus aureus (5.8%). Bacteria of fecal origin were found in vaginal introitus swabs in 33.8% of cases, most commonly Proteus mirabilis (14.4%), Enterococcus faecalis (12.2%), and Escherichia coli (7.0%). The finding of fecal flora was more common compared to controls, reaching a statistical significance (p < 0.05), as well as in girls aged up to 6 years (p < 0.001). Candida species were found in 2.4% of girls with vulvovaginitis symptoms. Conclusion: The microbial ecosystem in girls with clinical signs of vulvovaginitis is complex and variable, and the presence of a microorganism does not necessarily imply that it is the cause of infection. The diagnosis of vulvovaginitis in prepubertal girls requires a complex and comprehensive approach, and microbiological findings should be interpreted in the context of clinical findings.


Prepubertal girls Vulvovaginitis Infections Microbiological findings 


Conflict of interest

The authors did not receive any financial or other support for their study.


  1. 1.
    Altun Ö, Alpay H, Biyikli NK, Kiyan G (2004) Unusual cause of vaginal discharge. Pediatr Int 46:109–110PubMedCrossRefGoogle Scholar
  2. 2.
    Banerjee K, Curtis E, de San LC, Graham JC (2004) Low prevalence of genital candidiasis in children. Eur J Clin Microbiol Infect Dis 23:696–698PubMedCrossRefGoogle Scholar
  3. 3.
    Cox RA (1997) Haemophilus influenzae: an underrated cause of vulvovaginitis in young girls. J Clin Pathol 50:765–768PubMedCrossRefGoogle Scholar
  4. 4.
    Cox RA, Slack MPE (2002) Clinical and microbiological features of Haemophilus influenzae vulvovaginitis in young girls. J Clin Pathol 55:961–964PubMedCrossRefGoogle Scholar
  5. 5.
    Creatsas G, Hassan E, Deligeoroglou E, Charalambidis V (1999) Combined oral and vaginal treatment of severe vulvovaginitis during childhood. J Pediatr Adolesc Gynecol 12:23–26PubMedCrossRefGoogle Scholar
  6. 6.
    Cuadros J, Mazon A, Martinez R, Gonzalez P, Gil-Setas A, Flores U et al (2004) The aetiology of paediatric inflammatory vulvovaginitis. Eur J Pediatr 163(2):105–107PubMedCrossRefGoogle Scholar
  7. 7.
    Dhar V, Roker K, Adhami Z, McKenzie S (1993) Streptococcal vulvovaginitis in girls. Pediatr Dermatol 10(4):366–367PubMedCrossRefGoogle Scholar
  8. 8.
    Fiorillo L (2004) Therapy of pediatric genital diseases. Dermatol Ther 17:117–128PubMedCrossRefGoogle Scholar
  9. 9.
    Fischer G (2001) Vulval disease in pre-pubertal girls. Australas J Dermatol 42:225–236PubMedCrossRefGoogle Scholar
  10. 10.
    Fischer G, Rogers M (2000) Vulvar disease in children: a clinical audit of 130 cases. Pediatr Dermatol 17(1):1–6PubMedCrossRefGoogle Scholar
  11. 11.
    Hansen MT, Sanchez VT, Eyster K, Hansen KA (2007) Streptococcus pyogenes pharyngeal colonization resulting in recurrent, prepubertal vulvovaginitis. J Pediatr Adolesc Gynecol 20:315–317PubMedCrossRefGoogle Scholar
  12. 12.
    Jaquiery A, Stylianopoulos A, Hogg G, Grover S (1999) Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract. Arch Dis Child 81:64–67PubMedCrossRefGoogle Scholar
  13. 13.
    Jasper JM (2009) Vulvovaginitis in the prepubertal child. Clin Pediatr Emerg Med 10:10–13CrossRefGoogle Scholar
  14. 14.
    Joishy M, Ashtekar CS, Jain A, Gonsalves R (2005) Do we need to treat vulvovaginitis in prepubertal girls? BMJ 330:186–188PubMedCrossRefGoogle Scholar
  15. 15.
    Koumantakis EE, Hassan EA, Deligeoroglou EK, Creatsas GK (1997) Vulvovaginitis during childhood and adolescence. J Pediatr Adolesc Gynecol 10(1):39–43PubMedGoogle Scholar
  16. 16.
    Liotta A, Cardella F, Ferrara D, Natoli D, Licastro G, Meli F et al (1987) Vaginal infections in a population of diabetic children and adolescents. Pediatr Med Chir 9(3):305–308PubMedGoogle Scholar
  17. 17.
    Mogielnicki NP, Schwartzman JD, Elliott JA (2000) Perineal group a streptococcal disease in a pediatric practice. Pediatrics 106:276–281PubMedCrossRefGoogle Scholar
  18. 18.
    Myhre AK, Bevanger LS, Berntzen K, Bratlid D (2002) Anogenital bacteriology in non-abused preschool children: a descriptive study of the aerobic genital flora and the isolation of anogenital Gardnerella vaginalis. Acta Paediatr 91:885–891PubMedCrossRefGoogle Scholar
  19. 19.
    Navratil F (2002) Genital infections in prepubertal girls. Ther Umsch 59(9):475–479PubMedCrossRefGoogle Scholar
  20. 20.
    O’Brien TJ (1995) Paediatric vulvovaginitis. Australas J Dermatol 36(4):216–218PubMedCrossRefGoogle Scholar
  21. 21.
    Petrova Ch, Shentov B, Tanchev S, Mikhaĭlov V, Sredkova M, Popova V (2004) Genital infections in girls with type 1 diabetes. Akush Ginekol (Sofiia) 43(4):21–25Google Scholar
  22. 22.
    Piippo S, Lenko H, Vuento R (2000) Vulvar symptoms in paediatric and adolescent patients. Acta Paediatr 89:431–435PubMedCrossRefGoogle Scholar
  23. 23.
    Randjelović G, Kocić B, Stojanović M, Mišić M, Mladenović V (2005) Bacteriological findings of the vulvar swab specimens from girls with vulvovaginitis. Facta Universitatis 12(3):159–163Google Scholar
  24. 24.
    Rees A, Mott A (2001) Management of vaginal discharge in pre-pubertal children. Curr Paediatr 11:375–380CrossRefGoogle Scholar
  25. 25.
    Stricker T, Navratil F, Sennhauser FH (2003) Vulvovaginitis in prepubertal girls. Arch Dis Child 88:324–326PubMedCrossRefGoogle Scholar
  26. 26.
    Van Eyk N, Allen L, Giesbrecht E, Jamieson MA, Kives S, Morris M et al (2009) Pediatric vulvovaginal disorders: a diagnostic approach and review of the literature. J Obstet Gynaecol Can 31(9):850–862PubMedGoogle Scholar
  27. 27.
    Van Neer PA, Korver CR (2000) Constipation presenting as recurrent vulvovaginitis in prepubertal children. J Am Acad Dermatol 43(4):718–719PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Gordana Ranđelović
    • 1
    Email author
  • Vesna Mladenović
    • 2
  • Ljiljana Ristić
    • 2
  • Suzana Otašević
    • 1
  • Sofija Branković
    • 3
  • Snežana Mladenović-Antić
    • 2
  • Milena Bogdanović
    • 1
  • Dragan Bogdanović
    • 4
  1. 1.Faculty of MedicineUniversity of NišNišSerbia
  2. 2.Center of MicrobiologyInstitute of Public Health NišNišSerbia
  3. 3.Department of PediatricsHealth Care Center NišNišSerbia
  4. 4.Center of Informatics and Biostatistic in HealthcareInstitute of Public HealthNišSerbia

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