title: Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children.
abstract: BACKGROUND
  Streptococcus pyogenes (group A Streptococcus) is the etiological agent of perineal infection in children, consisting of perianal infection, vulvovaginitis and balanitis. If it is not properly diagnosed and treated, it can persist for many months and can cause severe complications. Furthermore, treatment with penicillin can be followed by failures and recurrences.
  
  
  METHODS
  We report here the prevalence of S. pyogenes isolates in genital tract specimens from girls (n = 1692) with symptoms of vulvovaginitis and from boys (n = 52) with balanitis in the municipality of Nis, Southeast-Serbia (the Western Balkans) in a 10 year period, and the seasonal distribution, patient age and sensitivity to bacitracin and antimicrobial drugs used in the treatment of streptococcal infection.
  
  
  RESULTS
  Streptococcal vulvovaginitis was diagnosed in 2.30% of examinees. Of those cases, 64.10% were detected from April to September, and it was most common (71.79%) in girls aged 3-7 years. Streptococcal balanitis was diagnosed in two instances: in a 4-year-old boy and in a 7-year-old boy. S. pyogenes strains resistant to bacitracin were identified in five girls. Two isolates with M phenotype and five isolates with cMLSBphenotype were identified.
  
  
  CONCLUSIONS
  Streptococcal vulvovaginitis was diagnosed less often in the present study, but it was still far more common than streptococcal balanitis in childhood. Bacitracin resistance of S. pyogenes strains should be taken into account in routine microbiological identification, and the detection of S. pyogenes isolates resistant to erythromycin requires surveillance in the present geographical territory.
authors.affiliation: Faculty of Medicine, University of Nis, Niš, Serbia.|Center of Microbiology, Public Health Institute Nis, Niš, Serbia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Randjelovic
authors.affiliation: Faculty of Medicine, University of Nis, Niš, Serbia.|Center of Microbiology, Public Health Institute Nis, Niš, Serbia.
authors.forename: Suzana
authors.initials: S
authors.lastname: Otasevic
authors.affiliation: Center of Microbiology, Public Health Institute Nis, Niš, Serbia.
authors.forename: Snezana
authors.initials: S
authors.lastname: Mladenovic-Antic
authors.affiliation: Center of Microbiology, Public Health Institute Nis, Niš, Serbia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Mladenovic
authors.affiliation: Faculty of Medicine, University of Nis, Niš, Serbia.|Clinic of Nephrology, Clinical Centre of Nis, Niš, Serbia.
authors.forename: Radmila
authors.initials: R
authors.lastname: Radovanovic-Velickovic
authors.affiliation: Center of Microbiology, Public Health Institute Nis, Niš, Serbia.
authors.forename: Marina
authors.initials: M
authors.lastname: Randjelovic
authors.affiliation: Center of Microbiology, Public Health Institute Nis, Niš, Serbia.|Department of Biomedical Sciences, State University of Novi Pazar, Novi Pazar, Serbia.
authors.forename: Dragan
authors.initials: D
authors.lastname: Bogdanovic
mesh_terms: D001446:Balanitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D055771:Serbia / Q000453:epidemiology; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D014848:Vulvovaginitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*
keywords: 
  Streptococcus pyogenes
  ; balanitis; child; vulvovaginitis