title: Altered perineal microbiome is associated with vulvovaginitis and urinary tract infection in preadolescent girls.
abstract: BACKGROUND
  Vulvovaginitis has a known association with urinary tract infections (UTIs) in girls. We hypothesize that vulvovaginitis is a major contributor to UTIs in prepubertal girls by increasing periurethral colonization with uropathogens.
  
  
  METHODS
  Periurethral swabs and urine specimens were obtained from a total of 101 girls (58 with vulvovaginitis and 43 without vulvovaginitis). Specimens were cultured for bacterial growth. The dominant organism in the periurethral swabs and urine cultures was recorded and antibiotic sensitivity profiles were compared.
  
  
  RESULTS
  Periurethral swabs from children with vulvovaginitis were associated with a statistically significant increase in uropathogenic bacteria (79% Enterococcus species or Escherichia coli) as the dominant culture compared with swabs from girls without vaginitis (18%) (p < 0.05). In children with vulvovaginitis, 52% of the urine cultures were positive for UTIs, and the dominant organism in the urine cultures matched the species and antibiotic sensitivity profile of the corresponding periurethral swab. Only 11% of the urine cultures from girls without vulvovaginitis were positive for UTIs.
  
  
  CONCLUSIONS
  Vulvovaginitis may cause UTIs by altering the perineal biome such that there is increased colonization of uropathogens.
authors.affiliation: Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Ilya
authors.initials: I
authors.lastname: Gorbachinsky
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Sherertz
authors.affiliation: Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Russell
authors.affiliation: Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: L Spencer
authors.initials: LS
authors.lastname: Krane
authors.affiliation: Department of Urology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Hodges
keywords: bacteriuria; perineal biome; preadolescent; urinary tract infection; vulvovaginitis