Ra. Shapiro et al., Neisseria gonorrhea infections in girls younger than 12 years of age evaluated for vaginitis, PEDIATRICS, 104(6), 1999, pp. E721-E725
Objective. This study examined the prevalence of gonorrhea in girls <12 yea
rs of age who presented with vaginitis and in whom sexual abuse was not sus
pected.
Design. A prospective, consecutive patient series was performed in a pediat
ric emergency department with 90 000 visits per year and in 2 affiliated pe
diatric continuity clinics. All girls (Tanner I or II) between the ages of
12 months and 12 years, presenting with a chief complaint of vaginal discha
rge, burning, pain, or itching, were enrolled (n = 93). Patients were exclu
ded (n = 6) if there was a history of sexual abuse. The presence or absence
of vaginal discharge, vaginal erythema, or trauma was recorded. Physicians
were instructed to collect cultures for Neisseria gonorrhea (GC), Chlamydi
a trachomatis, and bacteria/yeast. Wet prep, urinalysis, urine culture, ser
um rapid plasma reagin, and fungal culture were obtained at the physician's
discretion.
Results. Of the girls, 43 had a vaginal discharge on examination. Of these
girls, 4 (9%) had GC, 9 (26%) had group A, B, or F streptococcus and 1 had
Staphylococcus aureus. Of the girls, 44 had no discharge on examination. In
this group, 3 had streptococcus infection and 2 had Candida albicans. Both
children with C albicans had been treated recently with systemic antibioti
cs. Those girls with a vaginal discharge on examination had a microbial eti
ology significantly more often than did those without discharge. All of the
girls with infection were Tanner I on genital examination.
Conclusions. The prevalence of unsuspected GC infection was high and emphas
izes the importance of culturing Tanner I girls for GC when they have a vag
inal discharge along with routine bacterial cultures. Testing and/or treati
ng for C albicans should be considered when there has been recent antibioti
c use. Girls with vaginal complaints but without vaginal discharge may have
a bacterial infection, but such diagnoses occur less frequently than with
girls who have a discharge.