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 Table of Contents    
Year : 2015  |  Volume : 81  |  Issue : 6  |  Page : 655

Streptococcal vulvovaginitis in adults: Not a rare entity

Department of Dermatology, Government Medical College, Kottayam, Kerala, India

Date of Web Publication28-Oct-2015

Correspondence Address:
Dr. Sadeep Melethil Sadanandan
Department of Dermatology, Government Medical College, Gandhinagar, Kottayam - 686 008, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0378-6323.168351

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How to cite this article:
Chandran V, Sadanandan SM, Seena P, Sobhanakumari K, Kurien G, Mohan V. Streptococcal vulvovaginitis in adults: Not a rare entity. Indian J Dermatol Venereol Leprol 2015;81:655

How to cite this URL:
Chandran V, Sadanandan SM, Seena P, Sobhanakumari K, Kurien G, Mohan V. Streptococcal vulvovaginitis in adults: Not a rare entity. Indian J Dermatol Venereol Leprol [serial online] 2015 [cited 2020 Nov 23];81:655. Available from:


We conducted a study to assess the prevalence, etiological factors and pattern of various vaginal infections in 65 patients who complained of symptomatic and excessive vaginal discharge. Patients with a history of using topical or systemic antifungals and antibiotics during the previous month were excluded from the study. A comprehensive history, clinical examination and relevant investigations were performed to confirm the diagnosis. The laboratory diagnosis of vulvovaginal candidiasis was made based on the identification of yeasts and pseudohyphae on 10% KOH mount, Gram stain, culture and an acidic vaginal pH. Bacterial vaginosis was diagnosed by applying Amsel's criteria and Gram stain to show alterations in the normal vaginal flora. Streptococcal vulvovaginitis was diagnosed on the basis of Gram stain, culture and pH study. Fifty seven patients were found to have vulvovaginitis. Candidiasis was seen in 37 (56.9%) patients, bacterial vaginosis in 16 (24.6%), and streptococcal vulvovaginitis in 4 (6.1%) of them. Among the remaining eight patients, six had mucorrhea and two had mucopurulent cervicitis. A significant observation was that there were four cases of streptococcal vulvovaginitis in adults. The details are summarized in [Table 1].
Table 1: Clinical and laboratory profile of patients with streptococcal vulvovaginitis

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Adad has compared the prevalence rates of various vaginal infections over four decades and found that there is a reduction in frequency of cervical and vaginal infections by Trichomonas vaginalis, with a rise in the frequency of candidiasis.[1] Our study has comparable findings. The reduction in prevalence of trichomoniasis may be attributed to widespread syndromic management of sexually transmitted diseases and happenstance treatment of cases. Group A streptococcal infection is a cause of vulvovaginitis in 21% of prepubescent girls. It is uncommon in adults and not well documented.[2] A personal or family history of skin or respiratory infection secondary to group A Streptococcus is an important risk factor.[2],[3] However, none of our patients gave such a history. The fourth case was diagnosed to have pelvic inflammatory disease and culture of the intrauterine contraceptive device revealed the presence of group A alpha hemolytic streptococci, making it the most likely source of infection. The source of infection in the other patients could be asymptomatic carriers among family members who could be harbouring the bacteria in their respiratory or gastrointestinal tract. However, we were unable to do a culture study among family members and partners, which is a limitation of our study.

The first patient was unsuccesfully treated with antifungals several times before being diagnosed with streptococcal vulvovaginitis. As she was allergic to penicillin, we treated her with oral erythromycin and topical clindamycin. The second and third patients were treated with oral amoxicillin and topical clindamycin. All of these patients responded well and showed no signs of relapse after one month of follow up. The fourth patient was screened for other sexually transmitted infections and referred to a gynecologist.

Streptococcal vulvovaginitis in adults may not be rare but is undetected due to lack of awareness or happenstance treatment with antibiotics for common infections. Clinically, most of the cases may be indistinguishable from vulvovaginal candidiasis or mixed infections, and empirical antifungal treatment is common. Therefore, streptococcal vulvovaginitis has to be considered in the differential diagnosis of any patient with significant vulvovaginal symptoms after other common causes have been ruled out.

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  References Top

Adad SJ, de Lima RV, Sawan ZT, Silva ML, de Souza MA, Saldanha JC, et al. Frequency of Trichomonas vaginalis, Candida sp. and Gardnerella vaginalis in cervical-vaginal smears in four different decades. Sao Paulo Med J 2001;119:200-5.  Back to cited text no. 1
Meltzer MC, Schwebke JR. Lactational amenorrhea as a risk factor for group a streptococcal vaginitis. Clin Infect Dis 2008;46:e112-5.  Back to cited text no. 2
Verstraelen H, Verhelst R, Vaneechoutte M, Temmerman M. Group A streptococcal vaginitis: An unrecognized cause of vaginal symptoms in adult women. Arch Gynecol Obstet 2011;284:95-8.  Back to cited text no. 3


  [Table 1]


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