Group A beta-hemolytic streptococcal vulvovaginitis: a recurring problem.

Differential diagnosis of purulent vulvovaginitis in prepubertal girls should include infection caused by group A beta-hemolytic streptococci. Cultures should be obtained not only for N. gonorrhoeae but also for respiratory and skin pathogens such as streptococci. While a specific diagnosis of group A streptococcal vulvovaginitis does not exclude child abuse or a vaginal foreign body, the child's symptoms and parental anxiety and concern can usually be rapidly alleviated with oral antibiotics effective against streptococci. Further investigation beyond culturing and treatment with antibiotics can be reserved for cases where history, physical findings, and response to therapy indicate such a need.