Pediatric emergency medicine trisk 2126 2126
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Shigella flexneri, Shigella sonnei, Shigella boydii, and Shigella dysenteriae can
produce vaginal infections in infants and children but do not appear to cause
genital disease after puberty. The vaginitis is characterized by a white to yellow
discharge that is bloody in three-fourths of cases. Associated pruritus and dysuria
are uncommon. One-third of patients have diarrhea that precedes, accompanies,
or follows the vaginal discharge. On inspection, the vulvar mucosa is often
inflamed or ulcerated.
Clinical Assessment
The diagnosis is established by culture of a specimen of vaginal discharge. Rectal
cultures are positive for Shigella species in some cases.
Management
Patients with Shigella vaginitis should be treated with oral antibiotics chosen on
the basis of sensitivity testing. If the antibiotic sensitivity is unknown,
trimethoprim-sulfamethoxazole (8 mg/kg/day orally of trimethoprim in two
divided doses for 5 days) should be used.
STREPTOCOCCAL VAGINITIS
Clinical Considerations
Clinical Recognition
S. pyogenes can be identified in cultures of vaginal specimens taken from about
14% of prepubertal girls with scarlet fever. Most of these vaginal infections
produce either no symptoms or minor discomfort, but a few patients develop
outright vaginitis with a purulent discharge. Streptococcal vaginitis can
accompany or follow symptomatic pharyngitis and causes genital pain or pruritus
which can mimic candidal or gonococcal vaginitis.
Clinical Assessment
A swab of the patient’s discharge should be cultured to verify the clinical
diagnosis. Testing for other potential etiologies, such as gonococcal infection,
should be considered on a case-by-case basis.
Management
As for any other infection with group A β-hemolytic streptococci, penicillin is the
preferred antibiotic. Intramuscular benzathine penicillin G is an alternative if poor
compliance with oral treatment is anticipated. For some patients who are allergic
