Management of vaginal discharge in pre-pubertal children

Abstract 

The management of vaginal discharge in pre-pubertal girls is a common problem facing general practioners, paediatricians and paediatric gynaecologists. The management is to offer simple advice and reassurance, to exclude infection and foreign bodies and to recognize and treat dermatological conditions. Child sexual abuse should always be considered particularly where there is recurrent discharge with recognized pathogens. Some infections such as those due to Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis are always suspicious of sexual abuse.

Chronic recurrent discharge without recognized pathogens can be treated with topical oestrogen creams in short courses. Most of these children will experience resolution of their symptoms at the menarche.

Foreign bodies are a rare cause of vaginal discharge in pre-pubertal children but must be considered where there is a blood-stained discharge or recurrent offensive discharge.

Keywords: bacterial vaginosis, child abuse, Chlamydia trachomatis, gonorrhoea, Neisseria gonorrhoea, vaginal discharge, vaginitis, vulvovaginitis

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• f1 Correspondence to: AR. E-mail: shelagh.treby@lhct-tr.wales.nhs.uk