🩺 Vaginal Discharge · Vulvovaginitis · Schwartz Chapter 80

Premenarchal vs adolescent · physiologic leukorrhea · infectious vs non‑infectious · GAS · Candida · BV · trichomonas · foreign body · pinworms

Age-based differential – premenarchal girls lack estrogen → at risk for non‑specific vulvovaginitis, group A strep, Shigella, foreign body, pinworms. Adolescents: yeast, BV, trichomonas, STI (chlamydia, gonorrhea).
⚠️ Red flags: bloody discharge, severe pain, systemic illness, suspected sexual abuse, recurrent or persistent despite hygiene measures.

📋 Step 1 — Age, discharge characteristics & exposures
📌 Differential & treatment plan
📖 Schwartz Ch 80 (Vulvovaginitis)

Select age group (premenarchal vs adolescent), color/odor of discharge, associated pruritus, dysuria, fever, sexual activity, hygiene factors → tool suggests most likely etiology (non‑specific, GAS, Candida, BV, trichomonas, gonorrhea, chlamydia, pinworms, foreign body) and provides evidence‑based treatment.

✔️ Premenarchal: poor hygiene, bubble bath, GAS pharyngitis association, Shigella (bloody), pinworms (nocturnal itching).
✔️ Adolescents: physiologic leukorrhea, Candida (cottage cheese, pruritus), BV (fishy odor, clue cells), trichomonas (strawberry cervix), chlamydia/gonorrhea (mucopurulent).
✔️ Sexual abuse considered in any child with recurrent / unexplained infectious vulvovaginitis.
📘 Schwartz management pearls
• Premenarchal: gentle labial traction, avoid speculum. Topical barrier + improved hygiene.
• Group A strep: beefy red vulva, treat with penicillin/amoxicillin for 10 days.
• Pinworms: cellophane tape test, mebendazole or pyrantel pamoate, treat family.
• Candida: topical clotrimazole or oral fluconazole (adolescents).
• BV / trichomonas: metronidazole or tinidazole; treat sexual partners for trichomonas.