Hansen Megan T, Sanchez Veronica T, Eyster Kathleen, Hansen Keith A
Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois, USA.
J Pediatr Adolesc Gynecol. 2007 Oct;20(5):315-7. doi: 10.1016/j.jpag.2006.12.001.
Recurrent, prepubertal, vaginal infections are an uncommon, troublesome problem for the patient and her family. Failure of initial therapy to alleviate vulvovaginitis may be related to vulvar skin disease, foreign body, sexual abuse, pinworms, reactions to medications, anatomic anomalies, or allergies. This report describes a case of recurrent Streptococcus pyogenes vulvovaginitis secondary to presumed vaginal re-inoculation from pharyngeal colonization.
A 4-yr-old presented with one year of culture proven, recurrent Streptococcus pyogenes vulvovaginitis. Her symptoms repeatedly resolved with penicillin therapy, but continued to recur following cessation of antibiotic therapy. Evaluation included physical examination, trans-abdominal pelvic ultrasound, and vaginoscopy which all revealed normal upper and lower genital tract anatomy. Both the patient and her mother demonstrated culture proven, Group A Streptococcus pharyngeal colonization. Because of the possibility of repeated inoculations of the vaginal area from the colonized pharynx, they were both treated for decolonization with a regimen of amoxicillin and rifampin for ten days. Following this therapy there was resolution of vaginal symptoms with no further recurrence. Follow-up pharyngeal culture done on both mother and child on their last visit were negative for Group A Streptococcus.
This case demonstrated an unusual specific cause of recurrent vaginitis resulting from presumed self or maternal re-inoculation with group A beta-hemolytic streptococcus from pharyngeal colonization. Group A beta-hemolytic streptococcus are consistently sensitive to penicillin, but up to 25% of acute pharyngitis cases treated with penicillin having continued asymptomatic, bacterial carriage within the nasopharynx. Thus initial alleviation of symptoms in a patient with Group A beta-hemolytic vulvovaginitis treated with penicillin, can have continued asymptomatic pharyngeal colonization which can result in recurrence of the vulvovaginitis. This case stresses the importance of considering re-infection through this route in the patient with recurrent Group A beta-hemolytic streptococcus vulvovaginitis.
青春期前反复出现的阴道感染对患者及其家庭来说是一个不常见且棘手的问题。初始治疗未能缓解外阴阴道炎可能与外阴皮肤疾病、异物、性虐待、蛲虫、药物反应、解剖异常或过敏有关。本报告描述了一例复发性化脓性链球菌外阴阴道炎病例，推测是由于咽部定植菌再次接种到阴道所致。
一名4岁女童出现经培养证实的复发性化脓性链球菌外阴阴道炎，病程长达一年。她的症状经青霉素治疗后反复缓解，但抗生素治疗停止后仍继续复发。评估包括体格检查、经腹盆腔超声检查和阴道镜检查，所有检查均显示上、下生殖道解剖结构正常。患者及其母亲经培养证实均有A组链球菌咽部定植。由于存在定植于咽部的细菌反复接种到阴道区域的可能性，她们两人均接受了为期十天的阿莫西林和利福平联合治疗以消除定植菌。经过该治疗后，阴道症状消失，未再复发。在她们最后一次就诊时对母亲和孩子进行的后续咽部培养显示A组链球菌阴性。
本病例证明了复发性阴道炎的一种不寻常的特定病因，推测是由于A组β溶血性链球菌从咽部定植而自我或由母亲再次接种所致。A组β溶血性链球菌对青霉素始终敏感，但在接受青霉素治疗的急性咽炎病例中，高达25%的患者在鼻咽部持续存在无症状的细菌携带。因此，用青霉素治疗的A组β溶血性外阴阴道炎患者症状最初得到缓解后，咽部可能会持续存在无症状定植菌，这可能导致外阴阴道炎复发。本病例强调了在复发性A组β溶血性链球菌外阴阴道炎患者中考虑通过这种途径再次感染的重要性。
