Vaginitis or Vulvitis

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1. Group A streptococci. Common cause of vaginitis in prepubertal girls. Presents with serous discharge, marked erythema and irritation of the vulvar area, and discomfort on walking and urination.

2. Candida. Can also cause vaginitis but typically causes intense pruritus. Labia may be pale or erythematous with satellite lesions. Vaginal discharge, if present, is usually thick and adherent, with white curds. 3. Other causes. In sexually active adolescents, the most common causes include bacterial vaginosis ("fishy," foul-smelling discharge), candidal vulvovaginitis (white, "cottage-cheese'-appearing discharge), and trichomoniasis (malodorous yellow, frothy discharge).

D. Contact or Candidal Dermatitis. Frequently seen in infants wearing diapers because the diaper area is warm, often moist, and frequently contaminated by feces laden with organisms. Failure to change diapers frequently is a major predisposing factor. Harsh soaps, irritating chemicals, and detergents contribute to the process.

1. Irritant or contact dermatitis. Usually confined to convex surfaces of the perineum, lower abdomen, buttocks, and proximal thighs; spares the intertriginous areas.

2. Candidal dermatitis. Appears as a bright red eruption, with sharp borders and pinpoint satellite papules and pustules; tends to involve the intertriginous areas.

E. Urethral Stricture and Meatal Stenosis. Usually result from urethral trauma, either iatrogenic (catheterization or endoscopic procedures) or accidental (straddle injuries). Symptoms include decrease in force of the urine, bladder instability, hematuria, and dysuria.

F. Urinary Lithiasis. Most children with renal stones have an underlying metabolic abnormality. Exceptions include those with a neuropathic bladder and those who have urinary tract reconstruction with intestine. Pain from stones varies depending on location (see II, B, earlier).

G. Posterior Urethral Valves. Most common cause of bladder outlet obstruction in boys. In the presence of a persistent valve, the prostatic urethra becomes dilated, vesicoureteral reflux may be present, and a small bladder with hypertrophied walls develops. Infants may present with poor voiding stream, bilateral flank masses, or UTI and dysuria.

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