Concurrent infection of the urinary and genital systems in girls

Objective: to upgrade the quality of treatment in children with genital diseases associated with chronic urinary tract infection. Setting: Department of Obstetrics and Gynecology, Russian Medical Academy of Postgraduate Training; Department of Childhood Surgical Diseases, Russian Slate Medical University, Moscow. Subjects: 160 girls with concurrent urogynecologicaд infection (a study group), 100 girls with isolated vulvovaginitis (a control group). Methods: clinicoanamnestic examination, microscopy, bacteriological, cytological study of vaginal discharge, polymerase chain reaction, urinary bacteriological study. The significance was estimated by the χ 2 test and Fisher’s exact test; the differences between the values compared were considered to be significant at χ 2 > 3.8; p < 0.05. Results: in patients with nephrourological diseases, the symptoms of vulvovaginitis were detected in 80% of cases, the vast majority (92.5%) being girls aged less than 10 years. In girls with nephrourological diseases, among the infectious agents there was a preponderance of Escherichia coll in 43.7% of cases. In patients with concurrent urogynecological infection, Mycoplasma (M. hominis and U. urealiticum) and Chlamydia (C. trachomatis) were more frequently found in chronic than in acute course of an inflammatory process. The contrary was observed in girls with isolated vulvovaginitis wherein the above microorganisms were more common in the acute phase of the disease. Genital viral affliction was associated with the acute course of vulvovaginitis in both groups. Analysis of cytomorphograms showed no differences between the groups; the mucosa corresponded to the age period and blood estradiol level. Interpreting the cytomorphograms in terms of inflammatory changes revealed the discrepancy between the cytological and microscopic findings of vaginal smears in 39.3% of the prepubertal girls (under 9 years of age). Conclusion: there is evidence for the high prevalence of vulvovaginitis and its frequent concomitance with nephrourological diseases. Even having normal microscopic data, the girls with nephrourological diseases and visual signs of vulvovaginitis should undergo cytomorphological and bacteriological studies and diagnosis of genital infections. Cytological verification of an inflammation is a sufficient basis for etiotropic therapy of vulvovaginitis in concomitant urogynecological diseases.