INFECTIONS AND OTHER PATHOLOGIES IN PREPUBERTY (Part three)

Lichen Planus

It is the less common form that presents as reticular erosions on the vulva and oral mucosa. The oral form is asymptomatic. In other parts, it is associated with hair loss and a history of papular and pruritic lesions in other areas such as: the elbow, the dorsal part of the hand, the wrist, and the forearm.

Treatment is carried out with 2-week courses of steroids, one after the other. It begins with clobetasol propionate twice a day for 2 weeks, followed by fluticasone cream twice a day for another 2 weeks, continues with alclometasone twice a day for another 2 weeks, and finishes with 1% hydrocortisone cream twice a day for the last 2 weeks.

Anatomical Abnormalities

More often encountered in ectopic ureter, which opens into the vagina, perineum, or distal urethra, and drains urine at this level.

Diagnosis is confirmed through intravenous pyelography, ultrasound, CT, and MRI showing the urological structure and other malformations of the reproductive tract such as a small non-functional kidney.

Congenital Müllerian abnormalities in adolescence are associated with secondary pain from menstrual obstruction, while in prepuberty they rarely present with persistent vaginal discharges with odor caused by partial obstruction of the vaginal canal, leading to the superimposition of a bacterial infection.

Diagnosis is confirmed through the analysis of vaginal secretions and performing ultrasound, CT, and MRI.

Systemic Disease

Often vulvovaginitis are clinical presentations of many systemic diseases such as: Crohn's disease, Stevens-Johnson syndrome, diabetes, Kawasaki syndrome...

Secondary Contamination

Secondary contamination can come from the contact of the microorganism with the vulva and vagina, caused by a primary infection somewhere in the child's body. Initially, good perineal hygiene, sitz baths for rinsing, and local steroids to reduce inflammation are recommended for the infection.

If the infection recurs, vaginoscopy under anesthesia is performed.

Treatment is specific to the corresponding microorganism.
For Haemophilus influenzae, amoxicillin 20-40 mg/kg weight per os for 7 days is used.
For group A beta-hemolytic streptococcus, penicillin 125-250 mg 4 times a day for 10 days.
For Staphylococcus pneumoniae, penicillin 125-250 mg 4 times a day for 10 days.
For Shigella, trimethoprim 8 mg per day and sulfamethoxazole 40 mg/kg divided into 2 doses for 7 days.
For Staphylococcus aureus, which is normally found in the vagina, when symptoms present, treated with cephalexin 25-50 mg/kg per day orally for 7 days, dicloxacillin 25 mg/kg orally for 7 days, and augmentin 20-40 mg/kg per day orally for 7-10 days.

Trichomonas vaginalis

Trichomonas vaginalis is caused by a flagellated protozoan that depends on glycogen and rarely grows in a non-estrogenic environment. Rarely encountered under the age of 9 years. When encountered, sexual abuse must be ruled out, and an examination of the secretions for gonococcus (5-20%) and chlamydia (2-13%) should be made.

Clinically presents with viscous vaginal discharges, yellow to gray in color, itching, dysuria.
Diagnosis is confirmed through the analysis of vaginal secretions.
Treatment is carried out with metronidazole 15 mg/kg per day divided into 3 doses for 7 days.

Herpes simplex virus

Herpes simplex virus is caused by the Herpes simplex virus that presents types I and II. The incubation period lasts from 2-20 days.

The infection spreads transplacentally (uncommon), through direct contact, contact with contaminated hands, sexual abuse.

Clinically expressed with painful vesicles, ulcerations, fever, nausea, vomiting, headache, general weakness, inguinal adenopathy, urinary retention. In the case of an oral infection, it expressed with painful vesicles, ulcerations, mild gingivitis, pharyngitis.

Diagnosis: The characteristic appearance of the vesicles and culture of the vesicular secretions.

Differential diagnosis: with varicella, reactivated herpes zoster, ammonia dermatitis, trauma, syphilis, Stevens-Johnson syndrome, condyloma, impetigo, erythema multiforme.

Treatment is nonspecific. With acyclovir, sitz baths with running water, antibiotics in case of superimposed bacterial infections.

Neisseria gonorrhoeae

Gonorrhea is an infection caused by Neisseria gonorrhoeae. The infection is encountered at any age. In prepuberty, the child's vagina is affected, while in adolescence and older ages, the endocervix is affected. In prepuberty, the vagina, rectum, pharynx, and conjunctiva are more affected because the cervix is closed until the age of 9-10 years. Incubation lasts 1 week and symptoms appear after 2-7 days.

Clinically presents with viscous, purulent vaginal discharges, neonatal ophthalmia.
Complications include: arthritis, meningitis, conjunctivitis, peritonitis.

Treatment: In addition to this infection, treatment for Chlamydia trachomatis is also carried out because these 2 infections often accompany each other. In uncomplicated infections, ceftriaxone im under 45 kg use 125 mg im while over 45 kg 250 mg im, spectinomycin 40 mg/kg im, and in children over 8 years old use doxycycline 100 mg twice a day for 7 days. In infections accompanied by complications, treatment is carried out with ceftriaxone in an extended manner.