NONSPECIFIC VAGINITIS (NSV) FOLLOWING SEXUAL ABUSE IN CHILDREN

Abstract

NSV, one of the most common causes of vaginitis in adults, is a polymicrobial infection in which vaginal anaerobes act synergistically with Gardnerella vaginalis. The diagnosis is made by examination of the vaginal secretions for clue cells, the development of a fishy odor after the addition of 10% KOH and a pH^≥4.5. To determine if NSV may occur in sexually abused children, we obtained vaginal washes from 31 abused and 28 control children, 2.5 to 13 years of age. A wash was considered definite for NSV if it contained both clue cells and odor; possible if it contained either clue cells or odor. We did not use pH since the normal range has not been standardized in prepubertal girls. Possible NSV (odor only) was found in only 1(4%) control. She was asymptomatic and her f/u exam was normal. Only 1 abused child had possible NSV (odor) detected at the initial exam, ≤ 48 hours after the episode of abuse, whereas 8(26%) developed definite(4) or possible(4) NSV at the f/u visit ≥ 7 days after the episode of abuse or rape. Five of these girls developed either a new vaginal discharge or dysuria; 3 were treated with metronidazole with resolution of the symptoms and reversion of the vaginal wash to normal.

These findings suggest that NSV is uncommon in normal children and that it can be acquired after sexual abuse. NSV was the most frequent cause of vaginitis in the abused girls in this study Examination of a vaginal wash for clue cells and odor should be part of the routine evaluation of sexually abused children.

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