title: Microbiological aspects of vulvovaginitis in prepubertal girls.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia. gordanar@medfak.ni.ac.rs
authors.forename: Gordana
authors.initials: G
authors.lastname: Ranđelović
authors.forename: Vesna
authors.initials: V
authors.lastname: Mladenović
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Ristić
authors.forename: Suzana
authors.initials: S
authors.lastname: Otašević
authors.forename: Sofija
authors.initials: S
authors.lastname: Branković
authors.forename: Snežana
authors.initials: S
authors.lastname: Mladenović-Antić
authors.forename: Milena
authors.initials: M
authors.lastname: Bogdanović
authors.forename: Dragan
authors.initials: D
authors.lastname: Bogdanović
mesh_terms: D017677:Age Distribution; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications* / Q000175:diagnosis; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D013293:Enterococcus faecalis / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000175:diagnosis; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000175:diagnosis; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D011513:Proteus mirabilis / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D014848:Vulvovaginitis / Q000382:microbiology*