Vulvitis - inflammation of the female external genitalia due to injury or infection. Vulvitis can affect the vestibule of the vagina, the labia, the clitoris, the outer part of the urethra. The disease ranks first among all gynecological infections in girls aged 1-8 years. It is about 65-70%.
Primary vulvitis in girls is more common due to the anatomical features of the genitals. With prolonged and recurrent vulvitis at a younger age, in the future there may be a violation menstrual cycle, reproduction problems.
Causes
At birth, girls' genitals are sterile. Gradually, conditionally pathogenic microorganisms appear on their mucosa. Initially, the vaginal environment has a slightly alkaline or neutral pH. There are no lactobacilli in the smear, leukocytes and mixed microflora are present. Lactobacilli appear at puberty. Gradually, the vaginal environment is oxidized, glycogen begins to be produced. It becomes similar in composition of the microflora of sexually mature women in girls with the advent of menstrual cycles.
The immediate causes of vulvitis are nonspecific or specific infections:
- viruses (adenovirus, influenza, papillomavirus);
- fungi;
- protozoa;
- chlamydia;
- gonococci.
Ways of transmission of infection:
- in newborns, infection can occur when passing through an infected birth canal;
- at a younger age, the household way prevails (in places of mass use, in case of non-compliance with hygiene rules);
- with sexual experience in adolescents - sexually.
Often vulvitis occurs in the presence of helminthic invasions or penetration of foreign objects (grains of sand, insects, blades of grass) into the genitals.
Secondary vulvitis in girls develops as a result of the spread of infection into the vulva from other foci (with tonsillitis, caries).
Fungal infection of the vulva is due to:
- taking antibiotics;
- endocrine disorders;
- weakening of the immune system.
If an allergic reaction occurs to certain irritants (fragrant detergents, pads, chocolate, citrus fruits) develops atopic vulvitis. It doesn't occur often.
The mucous membrane of the genital organs can be damaged with frequent diligent washing with soap, wearing tight underwear, improperly selected diapers.
Anomalies of the genitals also predispose to vulvitis:
- no posterior commissure;
- abnormal development of the external genitalia;
- low position of the urethral opening.
Signs and symptoms
Symptoms of vulvitis in children are in many ways similar to other infections of the genital organs (colpitis, vulvovaginitis).
Signs of the disease:
- burning and itching;
- pain in the genital area, which becomes more intense when urinating;
- swelling and redness of the clitoris, labia, vulvar mucosa;
- sometimes there are erosions and sores on the mucosa.
Vulvitis in girls is characterized by vaginal discharge (leucorrhea). They can be different, depending on the type and cause of the disease. They are mostly clear, but can sometimes be purulent or bloody. If the cause of the disease is Escherichia coli, then the whites have an unpleasant fecal odor and a greenish-yellow color. If the infection develops when the vulva is affected by staphylococci, they are viscous and yellow. Fungal vulvitis is accompanied by cheesy, white discharge.
Sometimes the disease can be accompanied by general symptoms:
- temperature increase;
- enlarged lymph nodes;
- nervousness;
- sleep disturbance;
- irritability.
If pinworms provoked vulvitis, the anal folds thicken and redden in girls, abdominal pain appears, and appetite worsens.
When the disease becomes chronic, the swelling and hyperemia become less pronounced, and itching and leucorrhoea persist. With relapses of vulvitis, complications can develop in the form of cystitis, cervical erosion, urethritis, and vaginal atresia.
Diagnostics
The disease can be diagnosed by a pediatrician. But a pediatric gynecologist should examine, observe and treat the child. He examines the genitals, uses instrumental vaginoscopy and vulvoscopy.
To identify the causative agent of infection, are assigned laboratory methods diagnostics:
- bakposev and microbiological examination of the smear;
- scraping by PCR;
- general analysis of blood and urine;
- analysis of feces for worms;
- scraping for enterobiasis;
- allergy tests.
A selection of effective treatments
Treatment of vulvitis in girls consists of a set of measures depending on the etiology of the infection.
Note! It is possible to treat a child at home only if the disease proceeds in a mild form without complications.
Nutrition and mode
In an acute process, girls need to provide bed rest. At the time of illness, you should change the diet. Reduce the intake of foods that promote the formation of acids and spices (fried, meat broths, smoked, pickled vegetables, sour fruits). In the diet, you need to increase alkalizing foods (milk, fresh and boiled vegetables). If vulvitis is allergic in nature, a hypoallergenic diet is indicated. It implies the exclusion from the diet of allergenic foods:
- nuts;
- eggs;
- citrus;
- chocolate;
After an acute period, to restore the microflora of the vagina and intestines, you can diversify the menu with fermented milk products.
Local therapy
It is indicated for the elimination of hyperemia and swelling of the genital organs, the removal of unpleasant symptoms of burning and itching. To do this, use disinfectants in the form of baths, irrigation, lotions.
Local antiseptics:
- A solution of potassium permanganate (light pink shade);
- Chlorhexidine;
- Miramistin;
- Furacilin;
- Chinosol.
Herbal infusions:
- calendula;
- chamomile;
- sage;
- nettle;
- succession;
- oak bark.
Read the instructions for use of Ambrobene solution for inhalation at the address.
Inflamed areas can be effectively treated with ointments:
- Tetracycline (after 8 years);
- Olethetrinic;
- Sangiviritin 1%;
- Erythromycin.
Apply the ointment carefully on pre-washed and dry genitals. Prolonged use of ointments is not recommended. If the inflammation does not go away, you need to show the child to the doctor to correct the treatment.
With the recurrent nature of the disease, estrogens (Folliculin, Estriol) are applied topically to accelerate the reparative processes.
Systemic treatment
When the nature of the vulvitis and its causative agent are determined, the doctor may prescribe oral medications.
Candidiasis vulvitis is treated with antimycotic agents:
- Levorin;
- Fluconazole;
- Itraconazole.
At the same time, inflammation sites are treated locally with antifungal ointments (Clotrimazole, Decamine ointment).
When trichomonads are detected within 7-10 days, the following are prescribed:
- Metronidazole;
- Tinidazole;
- Ornidazole.
With prolonged trichomonas vulvitis with relapses, Solcotrikhovac is administered intramuscularly (3 injections of ½ ml every 14 days). A second injection is carried out in a year - ½ ml once.
Gonococcal infections are treated with cephalosporin antibiotics:
- Cefatoxime;
- Cefix;
- Ceftriaxone.
In the presence of chlamydia and mycoplasmas, broad-spectrum antibiotics are prescribed:
- Sumamed;
- Doxycycline.
Vulvitis against the background of helminthic invasions begins to be treated with anthelmintic drugs:
- Wormil;
- Pirantel;
- Levamisole;
- Albendazole.
General state normalization
Be sure to take desensitizing agents with vulvitis to relieve swelling and itching:
- Suprastin;
- Tavegil;
- Zyrtec.
Enzymatic agents for the normalization of digestion:
- Baktisubtil;
- Creon;
- Wobenzym.
Immunomodulators to increase the protective functions of the body:
- Immunal;
- Immunoflazid.
Folk remedies and recipes
Methods can be highly effective in the treatment of vulvitis in girls. traditional medicine. Recipes:
- Infuse 1 tablespoon of St. John's wort in 200 ml of boiling water for 1 hour and strain. Take orally three times a day, 50 ml.
- 1 spoon of dried viburnum flowers pour a glass of water. Leave in a water bath for 10 minutes. Filter and drink 1 scoop three times a day.
- To relieve itching and burning, baths and washing with a decoction of chamomile or oak bark (2 tablespoons per 1 liter of water) are used externally.
Prevention measures
Preventive measures against this disease should be based on careful care for the genitals of girls and instilling hygiene rules with early years:
- In infants, change diapers and diapers immediately after contamination.
- Wash the perineum from front to back after each emptying.
- Wash underwear with a hypoallergenic detergent, rinse it well.
- Change panties twice a day.
- Soap should not be used to wash the perineum more than once a day. Its pH should be neutral.
- Linen should be made from natural fabrics that do not contain aggressive dyes.
- Do not use aromatic oils, powders, creams.
- Have separate hygiene items (washcloth, towel).
It is better to prevent any disease than to spend great efforts to treat it. Vulvitis in girls often occurs due to improper care of the genitals. Therefore, from an early age, parents should pay great attention to the hygiene of the child, timely detect infections and treat them. This will help avoid negative consequences for women's health in future.
Video. Dr. Komarovsky about the causes of vulvitis and vulvovaginitis in girls:
Unfortunately, sexually transmitted infections (STIs) occur not only among adults, but also among children, so pediatricians also face their diagnosis and treatment.
Babies can get STIs from infected mothers (in the womb, during childbirth or breastfeeding). Possible household route of transmission. HIV and hepatitis are spread through intravenous drug use. And finally, the direct sexual route of infection among children and adolescents also takes place, and often.
Features of the treatment of genital infections in children
Among children, there are all the same types of genital infections as among adults. Treatment of a child with suspected STIs should be carried out after a thorough diagnosis, which has its own characteristics due to the age of the patient. For example, the clarification of a child's sexual history should take place with the consent of the parents or other legal representatives.
Examination of the genitals of the child and taking material for research should be carried out by a doctor who has sufficient experience in conducting such procedures in children.
Treatment of genital infections in children is carried out on the basis of clinical data and results. laboratory research. The clinical picture of some genital infections in children may have a different picture from adults, which is associated with the characteristics of children's immunity.
For example, the course of gonorrhea in young girls can be very acute and require hospital treatment.
Drugs prescribed for the treatment of genital infections in pediatric practice are selected taking into account age and individual tolerance. It should be remembered about the increased frequency of allergic reactions in young children.
Treatment of certain genital infections in children
As in adults, in children, the treatment of a sexually transmitted infection depends on the specific pathogen:
- Gonorrhea is treated with antibiotics from the penicillin or cephalosporin group; for the entire period of treatment, the child is prescribed bed rest;
- Urogenital trichomoniasis in children, as in adults, is treated with drugs from the imidazole group;
- Treatment of genital candidiasis begins with the topical application of antifungal drugs; with severe symptoms of the disease, antifungal agents are prescribed orally;
- Chlamydial infection in children is treated with drugs from the macrolide group. In children who contract chlamydia from infected mothers, the conjunctiva, oral mucosa, and respiratory system are often affected. In such cases, in addition to antibacterial, appropriate symptomatic therapy is prescribed.
As in adults, in children, in the treatment of sexual infections, it is especially important to strengthen the immune system. For this, interferon preparations and vitamins are prescribed.
If a child has an STI, careful prevention of the possibility of contracting a sexual infection in the future should be carried out. There is a need to educate older children and adolescents about safer sex.
All relatives of the child who are sick or carriers of STIs should be treated. All cases of detection of genital infections in children should be carefully examined for the likelihood of sexual violence against the child, including family violence.
This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.
Sexual infection in children
O. A. Sokolova
T. M. Logacheva
T. G. Dyadik
A. V. Malkoch, Candidate of Medical Sciences
City Clinical Hospital No. 14 im. V. G. Korolenko, RCCH, RSMU, Moscow
In recent decades, the importance of the problem of protecting the reproductive health of children and adolescents has increased. Social processes such as environmental degradation, urbanization, uncontrolled use medicines, in particular antibiotics, have a negative impact on the formation of the reproductive system of the child, its resistance to infectious environmental factors, the state of local immunity of the genital tract. All this leads to the spread of inflammatory diseases of the genitals in children.
The issues of treatment and rehabilitation of patients with inflammatory diseases of the external genitalia are relevant, since relapses and chronicity of inflammatory processes worsen the prognosis for generative function, which, in turn, is a social and economic problem.
The division of urogenital inflammatory diseases into specific and nonspecific has now become very conditional. Recent studies have shown that along with gonococci, trichomonas, chlamydia and other pathogens, opportunistic aerobic microorganisms are found in patients, while the microbial association with its inherent biological properties acts as an etiological factor. At the present stages, urogenital inflammatory diseases in many cases lose their inherent specificity of the clinical course. Cases of detection of mixed infections have become more frequent, and in microbial associations, the pathogenicity of each microbe increases. Diagnosis is difficult, the development of complications and relapses of the disease is possible, the clinical course of the infection changes.
Traditionally, it is customary to distinguish sexually transmitted diseases (syphilis, gonorrhea, trichomoniasis, chancroid, donovanosis, venereal lymphogranulomatosis) and sexually transmitted infections (diseases) (hepatitis, HIV, chlamydia, human papillomavirus infection, etc.). However, this division is gradually losing its significance, and at the moment all these diseases are united by the term "sexually transmitted infections" (STIs).
The incidence of STIs in last years progresses both among children and among adolescents. In 2002, the proportion of patients in the age group under 18 was: patients with gonorrhea - 6.8%, trichomoniasis - 2.3%, chlamydia - 3.4% of the number of cases. These figures may be somewhat underestimated due to the presence of commercial medical institutions that do not conduct statistical records of incidence, as well as the prevalence of self-medication, especially in the adolescent population. There is a trend towards "rejuvenation" of STIs.
The main routes of infection of children with STIs are:
- transplacental (HIV, viral hepatitis B and C, syphilis, papillomavirus infection);
- perinatal (HIV, viral hepatitis B and C, syphilis, gonococcal, trichomonas, chlamydia and papillomavirus infections);
- transmission of infection in breastfeeding(HIV; for viral hepatitis B and C, syphilis, the risk of infection is not clear enough);
- direct contact:
- autoinoculation (herpetic and papillomavirus infections);
- through household items;
- sexual contact (all STIs);
– transfusion (HIV, hepatitis).
Most foreign researchers put infection with STI pathogens during close household contacts or during autoinoculation in terms of prevalence in last place and regard such cases as casuistic (with the exception of herpes simplex viruses and human papillomavirus).
According to domestic researchers, the possibility of infection in these cases is not excluded, and according to the publications of some authors, infection of children by household contact is quite widespread (0.7% for gonorrhea, 26.1% for trichomoniasis, 66.1% for chlamydia). ) .
Previously, the sexual route of STI infection was more typical for adolescents (14–18 years old), but now the number of cases of sexual transmission of the infection has increased in the group of children under 12 years of age. According to various researchers, from 7.5 to 70% of the total number of diseases of the lower genitourinary tract in children are classified as STIs, while the prevalence of STIs in children with a history of sexual contact ranges from 0 to 26.3 %, chlamydia - from 3.9 to 17%, trichomoniasis - from 0 to 19.2%, syphilis - from 0 to 5.6%. The difference in rates is due to the fact that the incidence of STIs varies widely both in different regions and in populations within the same region.
According to social surveys conducted among children and adolescents, about 15% of girls and 22% of boys noted the presence of sexual contacts in their lives, while 50% of them indicated that the first sexual intercourse was committed before the age of 15, and in 5% of girls and 2% of boys, it occurred before the age of 12 years.
Given the psychological and physiological immaturity of the child's body, any form of sexual contact with a child is sexual abuse. In our country, the problem of sexual violence against children has always received little attention. In a survey of Moscow and St. Petersburg schoolchildren conducted in 1993, 24% of girls and 11% of boys indicated a history of sexual coercion. The data of a sociological survey conducted in 21 countries of the world indicate that from 7 to 36% of women and from 3 to 29% of men become victims of sexual violence under the age of 18.
Cases of sexual violence in the family are a separate problem. The objects of violence most often are children aged 5-10 years, both boys and girls. According to various authors, about 50% of all cases of sexual violence occur in the family. Domestic violence, as a rule, is of a long-term nature (it is noted for many years), leads to chronic trauma of the child and greatly increases the risk of infection with STI pathogens.
Counseling of a child with suspected STIs should be carried out by specialists who have the skills to examine the child and obtain the clinical material necessary for the study. Of great importance is the study of medical and social history, carried out with the consent of the child's parents or persons representing his interests.
However, the causes of inflammation of the urogenital region are diverse, they can be infectious and non-infectious in nature, occur primarily or secondarily. In this regard, the examination of children should be comprehensive: clarification of anamnesis, general status, identification of concomitant diseases that may have caused inflammation of the urogenital tract. If a child is suspected of having an STI laboratory diagnostics must necessarily include the isolation of a pure culture, which allows a correct diagnosis to be made.
Vulvitis and vulvovaginitis
Inflammation of the external genitalia is primary and secondary. Primary vulvitis occurs with errors in caring for a child, with injuries, diabetes, helminthiasis, urinary incontinence, furunculosis.
In girls, the frequency of primary vulvitis is associated with the imperfection of endocrine and immunological processes, as well as the anatomical and physiological characteristics of the genital organs (tender skin, a large number of vestibular glands).
Secondary vulvitis occurs as a result of inflammatory processes in the internal genital organs (colpitis). In childhood, the development of vaginitis contributes to ovarian hypofunction.
The clinic of vulvitis depends on the severity of the process. With the activity of the process, the tissues of the vulva are edematous, there is hyperemia of the large and small labia. Often, all these symptoms are diffuse in nature, not only the vulva is affected, but also the inguinal folds, the inguinal lymph nodes increase. Patients complain of itching in the vulva, purulent discharge from the genital tract. Watery discharge of a yellowish-green color occurs when E. coli is affected. With staphylococcal lesions, the discharge is thick, yellow-white.
Therapy of nonspecific vulvitis should be complex. The external genitalia are treated with disinfectant solutions 5-6 times a day (2% oil solution of chlorphyllipt; 0.5% dioxidine solution; chamomile, string, calendula). Be sure to conduct desensitizing (Fenistil, Elidel), sedative therapy (Valerian).
Vulvovaginitis most often develops in girls aged 3–8 years. This is due to the fact that their epithelium does not contain glycogen, the mucous membrane is loose, tender, vulnerable, the vaginal secret has an alkaline reaction. Vulvovaginitis accounts for 65% of all diseases of the genital organs in childhood. Its occurrence is facilitated by violations of the function of the genital organs, common infectious diseases, endocrine disorders, helminthiasis, ingress of foreign bodies.
Clinical manifestations depend on the severity of the process, but they can be very similar to those of vulvitis.
Treatment is aimed at eliminating the cause of the disease. Sanitation of foci of infection, treatment of helminthiases, extragenital diseases, endocrine disorders are necessary. Vulvovaginitis in girls, caused by the ingress of a foreign body into the vagina, proceeds rapidly and is accompanied by copious purulent discharge from the genital tract.
Local treatment of vulvovaginitis is similar to the treatment of vulvitis, but douching of the vagina with solutions of furacilin, octenisept, dioxidine is added to the therapy, followed by the introduction of antibiotics into the vagina in the form of cocoa butter sticks.
It is also shown to take vitamin preparations (Vitrum, Unicap), dufalac (10–20 ml 1 time per day) or bifidumbacterin (10 doses per day).
Gonococcal infection
The causative agent of gonococcal infection is the gram-negative diplococcus N. gonorrhoeae. Gonorrhea is a sexually transmitted disease that affects both boys and girls, but gonorrhea is 10 to 15 times more common among girls. Favorable morphological and functional physiological conditions for the vital activity of the infection in their genitourinary organs are considered a factor that determines the development of the gonococcal process in children. Children aged 3–12 years are more often ill.
The frequency of infection with gonococci in girls depends on age, chronological fluctuations in immunity and hormonal status. In newborns, gonorrhea is rare due to passive maternal immunity and the presence of maternal estrogen hormones.
At the age of 2-3 years, passive protective maternal antibodies are depleted, the level of estrogen saturation decreases. During this period, the state of the mucous membrane of the external genital organs and the vagina changes. In the cells of the cylindrical epithelium, the glycogen content decreases, the activity of diastase decreases, the vaginal discharge acquires an alkaline or neutral reaction, the Dederlein sticks disappear, which break down glycogen to lactate and thereby cause an acidic reaction, and the pathological microbial flora is activated.
In subsequent years of life, due to the activation of the function of the endocrine glands, an increase in the level of glycogen in the cells of the epithelium occurs, the pH becomes acidic, the population of Dederlein sticks is restored, displacing the pathogenic flora.
Gonorrhea in childhood has a number of features, the main of which are the multifocal lesions and the possibility of developing a disseminated process. With a multifocal lesion in girls, the vagina is involved in the process in 100% of cases, the urethra in 60%, and the rectum in 0.5%. The defeat of the mucous membranes occurs immediately after contact with gonococci, and subjective complaints and objective symptoms of the disease appear after the incubation period (from 1–3 days to 2–3 weeks). The clinic of gonorrhea in girls is sometimes characterized by a torpid, recurrent course, and in some cases it is asymptomatic. However, the most typical acute onset of the disease, which is characterized by abundant purulent discharge, diffuse hyperemia of the vulva, perineum, skin of the inner thighs, perianal folds. Girls complain of pain when urinating, tenesmus. The discharge is purulent, thick, greenish in color, sticks to the mucous membrane, and when dried, leaves crusts on the skin.
Ascending gonorrhea is rare, but the possibility of its development must be remembered, especially in the presence of cervicitis. The disease is promoted by the absence of a barrier in girls in the form of a closed internal pharynx, the folds of the cervical canal do not end at the internal pharynx, as in adult women, but continue into the uterine cavity, the endometrium is affected. Primary gonorrheal endocervicitis in the "neutral period" (period of sexual calm from 2.5-3 years before the onset of puberty) in the absence or weak development of glandular tissue is rare. More often there is a secondary development of endocervicitis in the chronic course of gonorrhea in girls aged 8–10 years and older. Its course is usually torpid and sluggish. Often, the cervical mucosa is affected in girls of puberty, in which, however, bartholinitis practically does not occur.
Gonorrhea in boys proceeds almost the same as in adult men, but less acutely and with fewer complications, since the prostate gland and seminal vesicles are underdeveloped before puberty, the glandular apparatus of the urethra is underdeveloped. Patients feel pain, pain during urination, purulent discharge from the urethra, dysuria are noted. Sponges of the external opening of the urethra are edematous, hyperemic. Palpation of the urethra may be painful. Hyperemia and swelling can spread to the skin of the glans penis and foreskin. Purulent yellowish-greenish discharge flows freely from the urethra. Due to secretions, maceration of the inner leaf of the foreskin may develop. Erosions may form on the head of the penis. Possible balanitis and balanoposthitis. On the skin of the penis and adjacent areas of erosion are covered with crusts. In addition, there may be hyperemia of the skin of the penis and areas close to it, as well as the perianal region.
Traditionally, the diagnosis of gonorrhea is established on the basis of obtaining a pure culture of gonococcus in the clinical material from the patient and determining the saccharolytic properties. Fermentation of carbohydrates makes it possible to differentiate gonococcus from other gram-negative microorganisms, more often meningococcus and catarrhal micrococcus, which are often present in the urogenital tract of children.
Non-culture tests for gonorrhea, including Gram stain, DNA probes, or ELISA, should not be used without culture. Specimens from the vagina, urethra, pharynx, or rectum should be examined on selective media for the detection of gonococcus. All suspected materials from an N. gonorrhoeae outbreak should be positively identified, at least by tests based on various principles(biochemical and serological properties of the pathogen). With an appropriate clinical picture, the detection of gonococci in Gram-stained smears or the presence of a large number of erythrocytes in smears, even in the absence of flora, suggest gonorrhea.
A child with gonorrhea is hospitalized. Treatment of gonorrhea in childhood should be complex (antibiotic therapy, general strengthening therapy aimed at restoring the immune status).
In children, benzylpenicillin remains the drug of choice (course dose 4.2-6.8 million units). The drug is administered in single doses of 50-200 thousand units, depending on age, with an interval of 4 hours around the clock. The course lasts 5-7 days. Ceftriaxone is also used at a dose of 125 mg intramuscularly once with a body weight of less than 45 kg. During the entire period of antibiotic therapy, bed rest is prescribed with a daily change of linen.
The follow-up period is 5 months. During this time, children are not allowed in kindergartens, school attendance is allowed immediately after the end of treatment and the receipt of negative results of repeated bacteriological studies: three provocations and three sowings with an interval of 10 days.
With a torpid and long-term course of the disease, the observation period is extended to 1.5–2 months with repeated bacteriological and cultural studies.
It should be remembered that gonorrhea exacerbates pre-existing urinary tract infections. In this case, the clinical picture of the disease can change significantly. For example, trichomonas infection reduces the activity of gonococcus and "masks" the clinical manifestations of gonorrhea, while the combination of gonococcus and ureaplasma leads to greater activation of both pathogens. With such microbial associations, the processes of diagnosis and treatment become more complicated, which, in turn, contributes to the chronicity of the process. In any case, when an association of STI pathogens is identified, other infections are treated first, and then gonorrhea.
Urogenital trichomoniasis
On average, it accounts for 0.8 to 3.8% of cases.
Clinically, trichomonas vulvovaginitis is manifested by abundant liquid foamy secretions - from whitish to greenish in color. The disease is accompanied by severe itching of the vulva, possible admixture of blood in the secretions and the formation of erosions not only on the mucous membrane of the urogenital region, but also on the inner surface of the thighs.
None of the existing methods provides the detection of Trichomonas in all cases of the disease, so the key to successful diagnosis of trichomoniasis is a combination of different methods (microscopy of stained and native preparations and crops). Serological diagnostic methods have not received practical application, as they give a high percentage of false positive results due to the presence of several serovars of Trichomonas, a low level of immune response and long-term preservation of positive serological reactions in those cured of trichomoniasis. The diagnosis of trichomoniasis is necessarily confirmed by the detection of the pathogen by direct microscopy of pathological material, as well as by inoculation on artificial nutrient media (cultural examination), which significantly increases the reliability of diagnosis, especially in children.
For the treatment of trichomoniasis, children are prescribed metronidazole per os: at the age of 1 to 5 years, 1/3 tablet containing 250 mg, 2-3 times a day; 6-10 years - 0.125 g 2 times a day; 11-15 years - 0.25 g 2 times a day for 7 days.
The cure of urogenital trichomoniasis is established 7–10 days after completion of treatment using microscopic and cultural methods of investigation. Control examinations of recovered children are carried out monthly for 3 months.
Urogenital candidiasis
This is a lesion of the genitourinary organs by yeast-like fungi of the genus Candida. The species C. albicans prevails, less often the cause of the disease is C. tropicales, C. krusei. C. albicans has the most pronounced pathogenic properties among the pathogens of candidiasis.
Urogenital candidiasis in children develops in the presence of exogenous and / or endogenous risk factors.
To the factors contributing to the manifestation of pathogenic and invasive properties of fungi of the genus Candida, include congenital and acquired immunodeficiency states, general infections and intoxications, endocrinopathies, disturbance of the internal environment and the normal microbial "landscape" of the mucous membranes.
Diagnosis of urogenital candidiasis in children is based on clinical, microscopic and cultural data.
Clinical forms of candidiasis, which are treated in venereal clinics, are superficial lesions and are usually limited to the genital area. In children, urogenital candidiasis is detected less frequently than in adults, and usually occurs in the form of urethritis, balanoposthitis, vulvovaginitis and cystitis. Complaints of itching, burning in the anogenital region, vaginal discharge in the form of white cheesy masses, cheesy plaque on the mucous membranes of the genital organs dominate. Hyperemia of the skin and mucous membranes of the affected areas is noted. Recurrent urogenital candidiasis in children practically does not occur.
The clinical diagnosis of candidiasis must be confirmed by the identification of fungi of the genus Candida in preparations from pathological material under direct microscopy. microscopic examination allows not only to determine the presence of fungi of the genus Candida with the predominance of vegetative forms (mycelium and budding yeast cells), but also to assess the composition of the microflora (pathogenic and opportunistic microorganisms).
Cultural research, in turn, makes it possible not only to identify the pathogen, but also to assess sensitivity to drugs. Diagnostically significant is the titer of fungal colonies in the amount of more than 103 CFU / ml. The detection of fungi in the absence of symptoms of the disease is not an indication for the appointment of treatment, since they can periodically be detected in healthy people.
The tactics of managing children with urogenital candidiasis, according to the recommendations, involves the appointment of pimafucin, which is applied in case of vaginitis at a dose of 0.5-1.0 ml of the drug 1 time per day until the symptoms disappear. Oral forms are used 0.5 tablets 2-4 times a day. Ketoconazole in tablets of 0.2 g is administered orally with meals 2 times a day at the rate of 4–8 mg/kg of body weight, and with a body weight of more than 30 kg it is used in the same doses as for adults. Fluconazole is prescribed to children older than 1 year at the rate of 1-2 mg/kg of body weight per day.
The criteria for the cure of urogenital candidiasis are the disappearance of the clinical manifestations of the disease, the negative results of a microbiological study. The terms of observation are set individually, depending on the duration, the nature of clinical manifestations, the prevalence of urogenital candidiasis.
Urogenital chlamydia
Inflammatory diseases of the urogenital organs of chlamydial etiology in children today do not attract due attention of doctors. However, urogenital chlamydia is more common in children than other STIs. The causative agent of the infection is Chlamydia trachomatis. The incubation period is 10-14 days. Clinically, chlamydial infection can occur in a variety of ways. Currently with Chlamydia trachomatis bind:
- diseases of the genital and urinary tract (vulvovaginitis, urethritis, cystitis, pyelitis, pyelonephritis);
- diseases of the respiratory tract and ENT organs (sinusitis, otitis media, bronchitis and pneumonia);
- conjunctivitis;
- arthritis;
- Reiter's syndrome;
- diseases of the gastrointestinal tract (diarrhea);
- diseases of the cardiovascular system (myocardial damage).
Such a variety of clinical forms of chlamydial infection deserves close attention of doctors of many specialties.
Newborns can become infected perinatally. According to WHO, 60-70% of children born to mothers with chlamydial infection become infected. For older children, the main routes of infection are domestic and sexual.
Initially, chlamydial infection affects the mucous membranes (eye, oropharynx, urogenital tract, rectum). In newborns, infection caused by Chlamydia trachomatis, is often recognized on the basis of the symptoms of conjunctivitis and is the cause of ophthalmia. Chlamydia trachomatis is the most common cause of subacute pneumonia that is not accompanied by a rise in temperature and develops in the 1–3rd month of a child's life. In children aged 3–6 years, chlamydia often occurs as asymptomatic infections of the oropharynx, urogenital tract, and rectum.
Urogenital chlamydia in sexually active adolescents also occurs without clear clinical manifestations. The most constant symptom in girls is congestive hyperemia of the vulvar ring. Allocations, as a rule, are scanty, mucous, itching and burning during urination are slightly expressed. The asymptomatic or oligosymptomatic course of chlamydia increases the risk of developing an ascending infection, which is already quite high in children due to age features organism and the absence of factors of natural protection of the urogenital tract. Ascending chlamydial infection can lead to the development of complications in the form of various inflammatory diseases of the upper genital tract (endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis, as well as any combination thereof).
Testing for chlamydia, even in the absence of symptoms of the disease, is recommended for individuals at risk: sexually active adolescents; babies born to mothers who have not been treated for chlamydial infection; children whose parents are infected.
There are the following methods for detecting chlamydia: immunofluorescent, enzyme immunoassay, serological, cultural and DNA diagnostics. Early detection of chlamydia is an important prerequisite for preventing possible complications. For rapid diagnosis of chlamydia, it is preferable to use the method of direct immunofluorescence with monoclonal antibodies. In this case, not free secretions, but scrapings of epithelial cells are subject to research. If the results of the analysis in childhood are positive, it is necessary to use the cultural method of detection to confirm the diagnosis. Chlamydia trachomatis.
For the treatment of children with urogenital chlamydia, erythromycin is used at a dose of 50 mg/kg of body weight, divided into four oral doses for 10-14 days (when the body weight is less than 45 kg). For children weighing more than 45 kg, but under 8 years of age, erythromycin is used according to the regimens developed for the treatment of adults. In children
8 years and older use azithromycin or doxycycline at adult dosages.
To make sure that the patient is cured of urogenital chlamydia, a study should be carried out taking into account the diagnostic method. Cultural research is carried out no earlier than 2-3 weeks after the end of therapy. The criteria for cure of urogenital chlamydia are negative culture results and the absence of clinical symptoms of the disease.
Mycoplasmosis
Urogenital mycoplasmoses currently occupy a significant place among sexually transmitted diseases. In newborns, colonization of the genital tract by mycoplasmas occurs during childbirth. This infection is most often latent, asymptomatic, often aggravated by various stressful situations.
Clinical manifestations are erased. As a rule, patients talk about periodic, mild, spontaneously passing itching in the vulva. Against this background, mucous discharge from the genital tract appears.
Diagnosis of mycoplasmosis is based on the data of cultural diagnostics.
The complexity of treating the disease in childhood is due to the fact that tetracyclines and erythromycin are not used in pediatric practice. Treatment is carried out with the obligatory use of immunostimulating therapy (cycloferon), macrolides, cephalosporins in age dosages.
papillomavirus infection
The incubation period for papillomavirus infection ranges from 1 to 9 months, averaging 3 months. Genital warts have the appearance of single or multiple small papillary-type formations of a pale pink color on a short stalk.
In the initial period of the formation of genital warts, symptoms are often absent, and only with their rapid growth do patients seek help from a doctor. Main clinical manifestation is itching.
Depending on the location and size of genital warts, there are several methods of treatment. With the location of genital warts in the vulva, anorectal folds, it is possible to remove them with Solkovagin. This method is applicable for single warts. With a widespread, extensive process, its confluent nature, the use of laser therapy is preferable. Also an important direction in the treatment of this pathology is the use of antiviral drugs and immunostimulating therapy.
Thus, genital infection is a serious problem in childhood. The high frequency of detection of acute inflammatory diseases of the external genital organs in children (both in girls and boys), the great social significance of the consequences of these diseases for the gestational period - all this determines the need for increased attention to these patients by doctors of various specialties (pediatricians, dermatovenereologists, gynecologists, urologists, etc.), as well as complex diagnostics and treatment of children with this pathology, their allocation to a special dispensary group.
Literature
- Borisenko K.K. Diagnosis, treatment and disease prevention sexually transmitted: Methodical materials. 3rd ed. M.: Association SANAM, 1998. 134 p.
- Vasiliev M. M. Diagnosis, clinic and therapy of gonorrheal infection // Russian Medical Journal. 1998. V. 6. No. 15. S. 994–998.
- Ivanov O. L. Skin and venereal diseases (reference book). Moscow: Medicine, 1997. 352 p.
- Kisina V.I. Urogenital sexually transmitted infections in children: clinical aspects of diagnosis and treatment// Attending Physician. 2004. No. 5.
- Kisina V. I., Mirzabekova M. A., Stepanova M. A., Vakhnina T. E., Kolikova G. G. Microbiological characteristics of vulvovaginal candidiasis in patients with sexually transmitted infections: Proceedings of the 4th Symposium "New in dermatovenereology, andrology, gynecology: science and practice "//Bulletin of postgraduate medical education(special issue). 1999, p. 23.
- Kokolina V. N. Gynecology childhood. - M.: Medpraktika, 2003. 268 p.
- Lipova E.V., Borovik V.Z. Problems of diagnosing gonorrhea in children: Proceedings of the 3rd symposium "New in dermatovenereology, andrology, gynecology: science and practice" // Bulletin of postgraduate medical education (special issue). 1998.C . 23.
- Malova I. O. Vaginal discharge in girls: etiology, clinic, diagnosis, treatment. media/consilium. 2004.
- Molochkov V. A., Gosteva I. V., Goncharova L. I. The role of chlamydial infection in the development of chronic inflammatory diseases in children: Abstracts of the conference in memory of A. L. Mashkilleison. M., 1997. S. 55.
- Pathology of the vagina and cervix / Ed. V. I. Krasnopolsky. M.: Medicine, 1997. pp. 68–146.
- Guidelines for the treatment of sexually transmitted diseases. US Centers for Disease Control and Prevention, 2002. Moscow: Sanam, 2003. 72 p.
- Skripkin Yu.K., Mordovtsev VN Skin and venereal diseases. M.: Medicine, 1999. T. 1. 880 p.
- Standard principles for the examination and treatment of children and adolescents with gynecological diseases and disorders of sexual development / Ed. academician of RAMS, prof. V. I. Kulakova, prof. E. V. Uvarova. M.: Triada - X, 2004. S. 50–56.
- Shaposhnikov O. K. Venereal diseases. M.: Medicine, 1991. 544 p.
Inflammatory diseases of the genital organs occupy the 1st place in the structure of gynecological pathology of girls from 1 to 8 years old, accounting for about 65% of all diseases of the genital organs. Inflammatory lesions of the genital organs of girls can cause serious violations of menstrual, reproductive, sexual functions in adulthood. So, ulcerative lesions of the girl's vagina can cause its narrowing or infection and create an obstacle to sexual activity, pregnancy and childbirth in the future. In addition, long-term inflammatory diseases can cause a change in the functions of the hypothalamus - pituitary gland - ovaries.
In girls from 1 to 8 years of age, inflammation most often develops in the vulva and vagina.
What provokes / Causes of Urogenital infections in girls:
The cause of vulvovaginitis in girls can be specific (gonococci, mycobacterium tuberculosis, diphtheria bacillus) and non-specific (opportunistic aerobes and anaerobes, chlamydia, fungi, viruses, protozoa, etc.) infection. However, vulvovaginitis can also develop after the introduction of a foreign body, with helminthic invasion, onanism, impaired reactivity of the body due to secondary infection.
Ways of transmission of a specific infection are different. IN early age the domestic route of transmission of the infection prevails (through household items, common places, in case of violations of hygiene rules). Adolescent girls who have experienced sexual activity may be infected sexually.
Trichomonas vulvovaginitis is more common in adolescent girls who have experienced sexual activity. Possible family infection of girls (if parents are sick), as well as infection of newborns (when the fetus passes through an infected birth canal).
Mycotic vulvovaginitis can occur at any age, more often in infancy, early childhood and puberty. The most common causative agent of the disease are fungi of the genus Candida. Predispose to the disease: immunodeficiency, hypovitaminosis, antibiotic treatment, endocrine disorders.
Viral vulvovaginitis is rare in girls. Viruses (herpes, influenza, parainfluenza, urogenital virus, cytomegalovirus adenovirus, papillomavirus) can affect the vulva and vagina in isolation. Infection comes from patients. Perhaps transplacental infection and infection in childbirth.
Gonorrheal vulvovaginitis occurs at the age of 3-7 years, when the biological protection of the genitals is reduced. At an older age, the incidence of gonorrhea decreases, but sexual transmission is possible.
Diphtheria of the vulva and vagina develops secondarily after diphtheria of the pharynx and is less often primary.
Pathogenesis (what happens?) during Urogenital infections in girls:
Classification of vulvovaginitis in girls
- Infectious.
- Nonspecific vulvovaginitis.
- Specific vulvovaginitis:
- gonorrheal;
- tuberculosis;
- diphtheria.
- Primarily non-infectious.
- Vulvovaginitis caused by a foreign body in the vagina.
- Vulvovaginitis caused by helminthic invasion.
- Vulvovaginitis caused by onanism.
- Vulvovaginitis caused by a change in the reactivity of the body:
- metabolic disorders;
- dysmetabolic nephropathy;
- allergic diseases;
- intestinal dysbacteriosis;
- diseases of the urinary tract;
- acute viral diseases;
- childhood infections.
In 1955, Gardner and Duke proposed the term "nonspecific bacterial vaginitis" (banal, non-gonococcal). The clinic of such a disease did not have specific features. inflammatory process. Currently, the division of urogenital diseases into specific and nonspecific is rather arbitrary. Associations of microorganisms act as causative agents of vulvovaginitis, as a result of which the disease loses its clinical specificity.
Symptoms of urogenital infections in girls:
Vulvovaginitis in girls can occur acutely, but a chronic course is often observed. In acute vulvovaginitis, girls complain of purulent discharge from the genital tract, itching, burning in the vagina and in the vulva, aggravated by urination. These complaints usually occur when the inflammatory process spreads to the vulva. Sometimes there is pain in the vaginal area, in the lower abdomen with irradiation to the sacro-lumbar region. In addition to dysuric phenomena, patients often note constipation. With the transition of the disease to the chronic stage, hyperemia and exudation decrease, pain subsides. Complaints of purulent discharge from the genital tract and itching become predominant.
Diagnosis of urogenital infections in girls:
For the diagnosis of vulvovaginitis, an anamnesis (comorbidities, provoking moments - a foreign body, onanism, etc.) and complaints are important. On examination, swelling and hyperemia of the vulva are noted, which can spread to the skin of the thighs. With a long chronic course of the disease, hyperemia is replaced by pigmentation. The mucous membrane of the vestibule of the vagina may become macerated, erosions and small ulcers appear. Discharge from the genital tract is serous-purulent, purulent, with a foreign body in the vagina they have an admixture of blood.
Diagnosis is aided by additional research methods. Vaginoscopy determines the presence and extent of damage to the vagina and cervix, as well as a foreign body. Puffiness and hyperemia of the vaginal wall and vaginal portion of the cervix, punctate hemorrhages, erosion are noted. Microscopy of a native smear and a Gram-stained smear reveals an increased number of leukocytes in the field of view, gonococci, Trichomonas, and fungi. At the time of the examination, you can do a sowing of vaginal discharge on the flora and sensitivity to antibiotics. The specific nature of vulvovaginitis is detected by polymerase chain reaction (PCR). Worm infestation is confirmed by the study of feces for eggs of worms, scraping of the periscal region for enterobiasis.
Clinical signs of vulvovaginitis are determined mainly by the causative agent of the disease.
Trichomonas vulvovaginitis is manifested by abundant liquid secretions of whitish silt and greenish-yellow color. Often they foam, irritate the skin of the external genitalia, thighs, perineum. The disease is accompanied by severe itching of the vulva, as well as symptoms of urethritis. In the discharge, an admixture of blood is possible.
With mycotic lesions, the vulva is hyperemic, edematous, with whitish overlays, under which, when removed with a spatula, areas of bright hyperemia are found. Vaginal discharge looks like curd. Often the disease is accompanied by symptoms of urethritis, cystitis.
Chlamydial vulvovaginitis in most cases is chronic, with frequent relapses, complaints of periodic itching of the vulva. Possible burning sensation when urinating. The vulva is moderately hyperemic. Vaginoscopy reveals cervicitis, petechial hemorrhages, cervical erosion. Allocations are often scanty mucous, rarely purulent.
Urea- and mycoplasmal vulvovaginitis has no specific clinic. Usually, patients are concerned about serous-purulent discharge from the genital tract, often in combination with urethritis.
Herpetic vulvovaginitis is manifested by small vesicles on a hyperemic vulva. The vesicles contain a clear, and then, when a secondary infection is attached, a purulent fluid. After 5-7 days, the bubbles open with the formation of erosions and sores, which are covered with a scab. At the beginning of the disease, burning, pain and itching are expressed in the vulva. General symptoms include headache, chills, fever.
Gonorrheal vulvovaginitis in Girls is torpid, recurrent, and even asymptomatic, although the onset is most typically acute. The lesion is multifocal, usually the vagina (100%), the urethra (60%), and less often the rectum (0.5%) are involved.
After a 1-3-day incubation period, abundant purulent discharge, diffuse hyperemia of the external genital organs, perineum, skin of the inner thighs, and perianal folds appear. Girls complain of pain when urinating, tenesmus. Discharge from the genital tract is purulent, thick, greenish in color, sticks to the mucous membrane, and when dried, leaves crusts on the skin.
Diphtheria vulvovaginitis causes pain in the vulva, during urination, infiltration, severe swelling and redness of the vulva with a bluish tinge. During vaginoscopy, gray films are found on the vaginal mucosa, after removal of which bleeding erosions remain. Ulcers with necrotic changes and a yellowish coating are possible. Inguinal lymph nodes are enlarged, painful. Discharge from the genital tract is insignificant, serous or bloody-purulent with films. Local changes are accompanied by symptoms of general intoxication, fever.
Treatment of urogenital infections in girls:
With bacterial vulvovaginitis, the underlying disease is treated, foreign bodies are removed from the vagina. With helminthic invasion, deworming is indicated. Comprehensive treatment includes sanitation chronic foci infections, increased immunity and nonspecific resistance of the body.
As a local therapy, there are:
- sitz baths with infusion of herbs (chamomile, calendula, sage, mint, nettle, St. John's wort);
- washing the vagina with antiseptic solutions (3% hydrogen peroxide solution, 0.5% solutions of dioxidine, furacilin 1:5000, ethacridine lactate 1:5000, 3% lysozyme solution);
- ultraviolet irradiation of the vulva.
If there is no effect, vaginal sticks and ointments with antibiotics (polymyxin, neomycin, 5-10% synthomycin emulsion, levomekol, levosin, etc.), nitrofurans (furazolidone), estrogens (folliculin 500 IU) are prescribed. Subsequently, to accelerate epithelialization, ointments with vitamins A, E, solcoseryl, actovegin and other reparative agents are used topically.
With masturbation great importance given to proper education, sometimes sedative therapy is required.
As fortifying agents, multivitamins, brewer's yeast, methyluracil, immunal, eleutherococcus are used. With severe itching or a general reaction, hyposensitizing antihistamines are prescribed (diphenhydramine, tavegil, suprastin, diazolin, etc.).
In the treatment of urea- and mycoplasmal vulvovaginitis, antibiotics are used that are active against the pathogen - sumamed rulid, macropen. Topically apply ointments with tetracycline, erythromycin.
Treatment of diphtheria vulvovaginitis is specific and begins with the introduction of anti-diphtheria serum. Symptomatic therapy is prescribed, agents are introduced into the vagina that promote the healing of erosions and prevent cicatricial narrowing of the vagina.
Treatment of trichomoniasis, genital candidiasis, chlamydia, viral infections of the vagina, gonorrhea, tuberculosis is presented in the relevant sections.
Which doctors should you contact if you have Urogenital infections in girls:
Gynecologist
Are you worried about something? Do you want to know more detailed information about Urogenital infections in girls, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors examine you, study external signs and help to identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.
How to contact the clinic:
Phone of our clinic in Kyiv: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.
(+38 044) 206-20-00
If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.
You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.
If you want to ask a doctor a question, use the section online consultations maybe you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register on the medical portal Eurolaboratory to be constantly up to date with the latest news and information updates on the site, which will be automatically sent to you by mail.
