Majority of child vaginal discharge cases ‘do not need referral’
Most cases of recurrent vaginal discharge in young girls can be managed with simple hygiene measures and do not require referral, conclude UK researchers.
Their 15-year study looked retrospectively at the records of prepubertal children with recurrent vaginal discharge presenting at a specialist paediatric gynaecology service in Kettering, and found over 80% were due to vulvovaginitis.
Vaginal discharge is the most common gynaecological symptom in prepubertal girls presenting to GPs, but can be a sign of foreign bodies or sexual abuse.
NICE recommends that GPs should refer for suspected sexual abuse if a girl has a recurrent discharge that is associated with behavioural or emotional change and that has no medical explanation.
Out of the 110 girls identified by researchers between 1994 and 2009, recurrent discharge was due to vulvovaginitis in 82% of cases, 5% were due to suspected or confirmed sexual abuse, 3% due to foreign bodies, 3% due to labial adhesions and 2% due to vaginal agenesis.
Some 29% of those who had vulvovaginitis were treated with simple hygiene advice; a further 29% had vaginoscopy with some cases receiving further treatment including antibiotics, topical hormonal cream or topical steroids.
In the 5% who had suspected or confirmed sexual abuse, additional symptoms were noted by the researchers, including offensive discharge, vaginal soreness, blood staining and urinary symptoms.
Study author Mr Paul Wood, consultant gynaecologistand chair of the British Society for Paediatric and Adolescent Gynaecology, said the results show GPs could manage most cases of recurrent vaginal dischargewith simple hygiene advice such as wiping front to back after defecation, avoiding perfumed soaps and wearing cotton underwear.
He said: ‘Most cases of recurrent vaginal discharge are caused by vulvovaginitis and the first-line management should include a review of hygiene behaviour and appropriate behavioural advice, unless there are concerns of other underlying pathology or sexual abuse.'
But Dr Janice Allister, GP in Peterborough and RCGP clinical champion for child health, urged caution over not referring girls with symptoms.
She said: ‘Unless the GP was fairly certain there was no sexual maltreatment, it is better to refer for examination'
‘From the GP point of view, the important points are not to treat as thrush, to address poor hygiene, to consider sexual maltreatment, and refer appropriately within 12 hours if this is suspected.'
Journal of Pediatric and Adolescent Gynecology, online first 19 January 2012
Underlying causes for vaginal discharge
Vulvovaginitis - 82%
Due to suspected or confirmed sexual abuse – 5%
Foreign bodies – 5%
Labial adhesions – 3%
Vaginal agenesis – 2%
Suspected precoious puberty – 2%
Lichen sclerosus – 1%
Mullerian papilloma – 1%