Pediatric emergency medicine trisk 2122 2122
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Terconazole 80 mg vaginal
suppository
Oral agent: fluconazole 150
mg
Trichomoniasis Metronidazole
Tinidazole
One vaginally daily for 3 days
Once orally
2 g orally as single dose
2 g orally as single dose
a Over-the-counter
preparations.
Adapted from Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted
diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(RR-3):1–137.
Vaginitis should be suspected if there is discomfort or a change in the character
of their typical discharge. The etiology, clinical manifestations, diagnosis, and
treatment of common vaginal infections are presented in this chapter. For a
review of the differential diagnosis of vaginal bleeding and discharge, see
Chapters 79 Vaginal Bleeding and 80 Vaginal Discharge .
Table 92.1 summarizes the treatment of common vaginal infections.
Nonspecific vulvovaginitis is responsible for up to 75% of vaginitis in
prepubertal girls. Factors such as poor hygiene, bubble baths, and tight clothing
can increase the risk of vulvovaginitis but all prepubertal girls are at risk given
lack of labial development, unestrongenized thin mucosa, and alkaline vaginal
pH. That said, in symptomatic premenarcheal girls with vaginal discharge visible
on physical examination (as opposed to only irritation and erythema) up to 50%
will have specific vaginal infections that warrant antimicrobial treatment. Among
prepubertal girls in the United States, infections may be caused by respiratory
flora, Shigella species, Streptococcus pyogenes, and in infants (from maternal
passage) and after puberty has begun, Trichomonas vaginalis. Although
staphylococci and Haemophilus influenzae usually colonize the lower genital
tract without producing symptoms, they are associated with vaginal discharge in
only a small proportion of patients. Candida albicans is the most common
vaginal pathogen among both pubertal (but premenarcheal) and postmenarcheal
girls.
The relative prevalence of vaginal infections in a population of postmenarcheal
adolescents depends primarily on how many of them are sexually active.
Bacterial vaginosis is found commonly and nearly exclusively among sexually
active adolescents. Diabetes mellitus, pregnancy, immunodeficiency, and the use
of broad-spectrum antibiotics and corticosteroids predispose patients to
developing Candida vulvovaginitis, but the infection is most often seen in
patients who lack any of these risk factors. Trichomoniasis is transmitted
