title: Group A streptococcal vaginitis: an unrecognized cause of vaginal symptoms in adult women.
abstract: OBJECTIVE
  Vaginal infection with group A streptococci (GAS) is an established cause of vaginitis amongst prepubescent girls, but largely unrecognized in adult women and therefore often misdiagnosed as vulvovaginal candidosis. We sought to give an overview of the epidemiology, risk factors, symptoms, signs, and treatment of GAS vaginitis in adult women.
  
  
  METHODS
  Systematic literature search.
  
  
  RESULTS
  We identified nine case reports covering 12 patients with documented GAS vulvovaginitis. GAS vulvovaginitis in adult women is often associated with a predisposing factor: (1) household or personal history of dermal or respiratory infection due to GAS, (2) sexual contact, and (3) lactational or menopausal vaginal atrophy. Symptoms of GAS vulvovaginitis in adult women may include vaginal and/or vulvar pain, dyspareunia, burning sensation or irritation, and pruritus. In most cases, there is also profuse or copious vaginal discharge which may be watery, yellow, or even purulent. Whilst there are neither clinical trials nor treatment guidelines, treatment with oral penicillin or with vaginal clindamycin cream has been reported to result in rapid cure. In breast-feeding and postmenopausal women with vaginal atrophy, additional treatment with local estriol may be necessary to prevent recurrence. Finally, in case of recurrent GAS vulvovaginitis it will be necessary to assess the patients' asymptomatic household members for pharyngeal and anal carriage and to treat them accordingly.
  
  
  CONCLUSIONS
  Vaginal infection with GAS in adult women is a clearly defined entity and should be considered a diagnosis when more common causes of vaginitis have been ruled out.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. hans.verstraelen@ugent.be
authors.forename: Hans
authors.initials: H
authors.lastname: Verstraelen
authors.forename: Rita
authors.initials: R
authors.lastname: Verhelst
authors.forename: Mario
authors.initials: M
authors.lastname: Vaneechoutte
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D005260:Female; D006801:Humans; D010406:Penicillins / Q000627:therapeutic use; D012307:Risk Factors; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D013297:Streptococcus pyogenes; D016585:Vaginosis, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D010406:Penicillins