Shigella flexneri, Shigella sonnei, Shigella boydii, and Shigella dysenteriae can produce vaginal infections in infants and children but not appear to cause genital disease after puberty The vaginitis is characterized by a white to yellow discharge that is bloody in three-fourths of cases Associated pruritus and dysuria are uncommon One-third of patients have diarrhea that precedes, accompanies, or follows the vaginal discharge On inspection, the vulvar mucosa is often inflamed or ulcerated Clinical Assessment The diagnosis is established by culture of a specimen of vaginal discharge Rectal cultures are positive for Shigella species in some cases Management Patients with Shigella vaginitis should be treated with oral antibiotics chosen on the basis of sensitivity testing If the antibiotic sensitivity is unknown, trimethoprim-sulfamethoxazole (8 mg/kg/day orally of trimethoprim in two divided doses for days) should be used STREPTOCOCCAL VAGINITIS Clinical Considerations Clinical Recognition S pyogenes can be identified in cultures of vaginal specimens taken from about 14% of prepubertal girls with scarlet fever Most of these vaginal infections produce either no symptoms or minor discomfort, but a few patients develop outright vaginitis with a purulent discharge Streptococcal vaginitis can accompany or follow symptomatic pharyngitis and causes genital pain or pruritus which can mimic candidal or gonococcal vaginitis Clinical Assessment A swab of the patient’s discharge should be cultured to verify the clinical diagnosis Testing for other potential etiologies, such as gonococcal infection, should be considered on a case-by-case basis Management As for any other infection with group A β-hemolytic streptococci, penicillin is the preferred antibiotic Intramuscular benzathine penicillin G is an alternative if poor compliance with oral treatment is anticipated For some patients who are allergic