SHIGELLA VULVO-VAGINITIS IN PREPUBERTAL GIRLS

Shigella can produce acute vaginal infections in pediatric patients which may develop into recurrent or chronic vulvovaginitis. Because symptoms and clinical findings due to this disorder are similar to those caused by both foreign bodies and gonorrhoeal vaginitis, careful exploration is necessary to establish an adequate differential diagnosis. To assess this issue we investigated the frequency of Shigella infection as an etiological agent in an outpatient population with vulvovaginitis during 1988-1991. Nine hundred and twenty-six girls with vulvovaginitis were studied. Shigella was isolated from the vaginal discharge in 77 samples from 63 patients (6.8%). Ages ranged from 2.0 to 10.0 years (6.2 +/- 2.2). Fifty-one patients (81%) had bloody vaginal discharge and 12 (19%) had purulent discharge. Ten out of 32 (31%) reported diarrhea preceding the vaginal symptoms. Shigella flexneri was the most prevalent specie-68 cases (88.3%), followed by Shigella boydii-4 cases (5.2%), Shigella spp-3 cases (4%), and Shigella dysenteriae-2 cases (2.6%). These findings correlated with those of species usually found in stools from patients with diarrhea in our hospital. Stool cultures were carried out in 19 patients, and only one was positive for Shigella. Enterobius vermicularis was found in 26 (64%) of 40 patients with vulvovaginitis resulting from Shigella. Antibiotic therapy was initiated according to in vitro antimicrobial susceptibility which showed a high resistance to ampicillin (79%) and trimethoprim-sulfamethoxazole (76%). As a result of these findings, the high incidence of Shigella vulvovaginitis found in our population underscores the importance of performing specific cultures for this genus in patients with vulvovaginitis and the need to explore for Enterobius vermicularis infestation.