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36 - Vaginal discharge

from Part III - Management of specific disorders

Published online by Cambridge University Press:  04 May 2010

Rosamund Cox
Affiliation:
Kettering General Hospital, Kettering, UK
Paul Wood
Affiliation:
Kettering General Hospital, Kettering, UK
Adam H. Balen
Affiliation:
Leeds Teaching Hospitals, University Trust
Sarah M. Creighton
Affiliation:
University College London Hospitals
Melanie C. Davies
Affiliation:
University College London
Jane MacDougall
Affiliation:
Addenbrooke's Hospital, Cambridge
Richard Stanhope
Affiliation:
Great Ormond Street Hospital
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Summary

Vaginal discharge in childhood

Vaginal discharge is the most common gynaecological complaint in young girls. The majority are managed by general practitioners (primary care physicians) and referral to a gynaecologist tends to occur only if the patient fails to respond to treatment. It is, therefore, important that all those involved in the management of vaginal discharge in children understand the causes, so that the condition can be adequately investigated and treated.

History

The history is usually provided by the child's mother whose anxiety may be fuelled by concerns over the implications of abnormal vaginal discharge and the association with pelvic inflammatory disease (PID) recognized in older subjects. Such fears need to be allayed since there is no such proven association in prepubertal girls with vaginal discharge. Alternatively, family members may be concerned about a potential sexual abuse situation, although they perhaps will volunteer these fears less frequently. The child should be engaged in general conversation and asked questions about her complaints. In this way she can be involved in the consultation, can acknowledge that she is an important part of the process and can appreciate the need for an examination.

The duration, frequency and quantity of the discharge, its colour and associated odour need to be established along with details of previous treatments received. An offensive odour indicates anaerobic bacterial involvement.

Type
Chapter
Information
Paediatric and Adolescent Gynaecology
A Multidisciplinary Approach
, pp. 473 - 491
Publisher: Cambridge University Press
Print publication year: 2004

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References

Allen-Davis, J T, Russ, P, Karrer, F M, Shroyer, K, Ruyle, S, Odom, L F (1996). Cavernous lymphangioma presenting as a vaginal discharge in a six-year-old female: a case report. J Pediatr Adolesc Gynecol 9, 31–34CrossRefGoogle Scholar
Al-Salihi, F L, Curran, J P, Wang, J-S (1974). Neonatal Trichomonas vaginalis: report of three cases and review of the literature. Paediatrics 53, 196–200Google ScholarPubMed
Altchek, A (1972). Pediatric vulvovaginitis. Pediatr Clin North Am 19, 559–580CrossRefGoogle ScholarPubMed
Amsel, R, Totten, P A, Spiegel, C A, Chen, K C, Eschenbach, D, Holmes, K K (1983). Non-specific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 74, 14–22CrossRefGoogle Scholar
Anon. (2000). Sexually transmitted infections quarterly report: bacterial vaginosis. Trichomonas vaginalis and candidiasis in England and Wales. CDR Wkly (Online) 10, 350–352
Arsenault, P S, Gerbie, A B (1986). Vulvovaginitis in the preadolescent girl. Pediatr Ann 15, 577–585CrossRefGoogle ScholarPubMed
Bartley, D L, Morgan, L, Rimsza, M E (1987). Gardnerella vaginalis in prepubertal girls. Am J Dis Child 141, 1014–1017Google ScholarPubMed
Bell, T A, Holmes, K K (1984). Age-specific risks of syphilis, gonorrhea, and hospitalized pelvic inflammatory disease in sexually experienced US women. Sex Transm Dis 11, 291–295CrossRefGoogle Scholar
Berman S M, Hein K (1999). Adolescents and STDs. In Sexually Transmitted Diseases, 3rd edn, Holmes K K, Mårdh P- A, Sparling P F et al., eds., pp. 129–142. McGraw Hill, New York
Bickley, L S, Krisher, K K, Punsalang, A, Trupei, M A, Reichman, R C, Menegus, M A (1989). Comparison of direct fluorescent antibody, acridine orange, wet mount and culture for detection of Trichomonas vaginalis in women attending a public sexually transmitted diseases clinic. Sex Transm Dis 16, 127–131CrossRefGoogle ScholarPubMed
Bisno, A L (2001). Acute pharyngitis. N Engl J Med 344, 205–211CrossRefGoogle ScholarPubMed
Black, A, Redmond, A O B, Steen, H J, Oborska, I T (1990). Tolerance and safety of ciprofloxacin in paediatric patients. J Antimicrob Chemother 26(Suppl. F), 25–29CrossRefGoogle ScholarPubMed
Blackwell, A L, Fox, A R, Phillips, I, Barlow, D (1983). Anaerobic vaginosis (non-specific vaginitis): clinical, microbiological and theraputic findings. Lancet , 1379–382CrossRefGoogle Scholar
Blackwell, A L, Thomas, P D, Wareham, K, Emery, S J (1993). Health gains from screening for infection of the lower genital tract in women attending for termination of pregnancy. Lancet 342, 206–210CrossRefGoogle ScholarPubMed
Blake, D R, Duggan, A, Joffe, A (1999). Use of spun urine to enhance detection of Trichomonas vaginalis in adolescent women. Arch Pediatr Adolesc Med 153, 1222–1225CrossRefGoogle ScholarPubMed
Bowden, F J, Garnett, G P (2000). Trichomonas vaginalis epidemiology: parameterising and analysing a model of treatment interventions. Sex Transm Infect 76, 248–256CrossRefGoogle ScholarPubMed
Bro, F (1989). Patients with vaginal discharge in general practice. Acta Obstet Gynecol Scand 68, 41–43CrossRefGoogle ScholarPubMed
Brown, J L (1989). Hair shampooing technique and pediatric vulvovaginitis. Pediatrics 83, 146Google ScholarPubMed
Burch, T A, Rees, C W, Reardon, L V (1959). Epidemiological studies on human trichomoniasis. Am J Trop Med Hyg 8, 312–318CrossRefGoogle ScholarPubMed
Burstein, G R, Gaydos, C A, Diener-West, M, Howell, M R, Zenilman, J M, Quinn, T C (1998). Incident Chlamydia trachomatis infections among inner-city adolescent females. J Am Med Assoc 280, 521–526CrossRefGoogle ScholarPubMed
Carey, J C, Klebanoff, M A, Hauth, et al. (2000). Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 342, 534–540CrossRefGoogle ScholarPubMed
Catchpole, M (2001). Sexually transmitted infections: control strategies. Br Med J, 322, 1135–136CrossRefGoogle ScholarPubMed
*CDC (Centers for Disease Control and Prevention) (1998a). Guidelines for treatment of sexually transmitted diseases. MMWR 47, 61–62
*CDC (Centers for Disease Control and Prevention) (1998b). Guidelines for treatment of sexually transmitted diseases. MMWR 47, 79–84
Chen, K C, Forsyth, P S, Buchanan, T M, Holmes, K K (1979). Amine content of vaginal fluid from untreated and treated patients with nonspecific vaginitis. J Clin Invest 63, 828–835CrossRefGoogle ScholarPubMed
Clay, J C, Veeravahu, M, Smythe, R W (1988). Practical problems of diagnosing trichomoniasis in women. Genitourin Med 64, 115–117Google ScholarPubMed
Cowan, B D, Morrison, J C (1991). Management of abnormal genital bleeding in girls and women. N Engl J Med 324, 1710–1715Google ScholarPubMed
Cox, R A (1997). Haemophilus influenzae: an underrated cause of vulvovaginitis in young girls. J Clin Pathol 50, 765–768CrossRefGoogle ScholarPubMed
Dahiya, P, Sangwan, K, Khosla, A, Seth, N (1999). Foreign body in vagina: an uncommon cause of vaginitis in children. Indian J Pediatr 66, 466–467CrossRefGoogle ScholarPubMed
Davies, P O, Ridgway, G L (1997). The role of polymerase chain reaction and ligase chain reaction for the detection of Chlamydia trachomatis. Int J STD AIDS 81, 731–738CrossRefGoogle Scholar
Barbeyrac, B, Rodriguez, P, Dutilh, B, Roux, P, Bébéar, C (1995). Detection of Chlamydia trachomatis by ligase chain reaction compared with polymerase chain reaction and cell culture in urogenital specimens. Genitourin Med 71, 382–386Google ScholarPubMed
Jong, A R, (1985). Vaginitis due to Gardnerella vaginalis and to Candida albicans in sexual abuse. Child Abuse Negl 9, 27–29CrossRefGoogle ScholarPubMed
Dhaliwal, A K, Fink, J N (1995). Vaginal itching as a manifestation of seasonal allergic disease. J Allergy Clin Immunol 95, 780–782CrossRefGoogle ScholarPubMed
Dhar, V, Roker, K, Adhami, Z, McKenzie, S (1993). Streptococcal vulvovaginitis in girls. Pediatr Dermatol 10, 366–367CrossRefGoogle ScholarPubMed
Donald, F E, Slack, R C B, Colman, G (1991). Streptococcus pyogenes vulvovaginitis in children in Nottingham. Epidemiol Infect 106, 459–465CrossRefGoogle ScholarPubMed
Duncan, M E, Tibaux, G, Pelzer, Aet al. (1990). First coitus before menarche and risk of sexually transmitted disease. Lancet 335, 338–340CrossRefGoogle ScholarPubMed
*Dyson, C, Hosein, I K (1996). The role of the microbiology laboratory in the investigation of child sexual abuse. J Med Microbiol 45, 313–318CrossRefGoogle ScholarPubMed
Emans, S J, Woods, E R, Flagg, N T, Freeman, A (1987). Genital findings in sexually abused, symptomatic and asymptomatic, girls. Pediatrics 79, 778–785Google ScholarPubMed
Embree, J E, Lindsay, D, Williams, T, Peeling, R W, Wood, S, Morris, M (1996). Acceptability and usefulness of vaginal washes in premenarcheal girls as a diagnostic procedure for sexually transmitted diseases. Pediatr Infect Dis J 15, 662–667CrossRefGoogle ScholarPubMed
Eschenbach, D A, Hillier, S, Critchlow, C, Stevens, C, DeRouen, T, Holmes, K K (1988). Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 158, 819–828CrossRefGoogle ScholarPubMed
Farrington, P F (1997). Pediatric vulvovaginitis. Clin Obstet Gynecol 40, 135–140CrossRefGoogle Scholar
Figueroa-Colón, R, Grunow, J E, Torres-Pinedo, R, Rettig, P J (1984). Group A streptococcal proctitis and vulvovaginitis in a prepubertal girl. Pediatr Infect Dis 3, 439–442CrossRefGoogle Scholar
Folland, D S, Burke, R E, Hinman, A R, Schaffner, W (1977). Gonorrhoea in preadolescent children: an enquiry into source of infection and mode of transmission. Pediatrics 60, 153–156Google Scholar
Guss, C, Larsen, J G (1984). Group A beta-haemolytic streptococcal proctocolitis. Pediatr Infect Dis 3, 442–443CrossRefGoogle Scholar
Haddon, L, Heason, J, Fay, T, McPherson, M, Carlin, E M, Jushuf, I H A (1998). Managing STIs identified after testing outside genitourinary medicine departments: one model of case. Sex Transm Infect 74, 256–257CrossRefGoogle Scholar
*Hammerschlag, M R (1998). Sexually transmitted diseases in sexually abused children: medical and legal implications. Sex Transm Infect 74, 167–174CrossRefGoogle ScholarPubMed
Hammerschlag, M R, Alpert, S, Rosner, Iet al. (1978). Microbiology of the vagina in children: normal and potentially pathogenic organisms. Pediatrics 62, 57–62Google Scholar
Hammerschlag, M R, Cummings, M, Doraiswamy, B, Cox, P, McCormack, W M (1985). Nonspecific vaginitis following sexual abuse in children. Pediatrics 75, 1028–1031Google ScholarPubMed
Hauth, J C, Goldenberg, R L, Andrews, W W, DuBard, M B, Copper, R L (1995). Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 333, 1732–1736CrossRefGoogle ScholarPubMed
Hay, P E (1998). Therapy of bacterial vaginosis. J Antimicrob Chemother 41, 6–9CrossRefGoogle ScholarPubMed
Hay, P E, Lamont, R F, Taylor-Robinson, D, Morgan, D J, Ison, C, Pearson, J (1994). Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. Br Med J 308, 295–298CrossRefGoogle ScholarPubMed
Hill G B, Eschenbach D A, Holmes K K (1984). Bacteriology of the vagina. In Bacterial Vaginosis. Mårdh, P-A, Taylor-Robinson D, eds., pp. 23–39. Almqvist & Wiksell, Stockholm, Sweden
Ingram, D L, White, S T, Durfee, M F, Pearson, A W (1982). Sexual contact in children with gonorrhoea. Am J Dis Child 136, 994–996Google Scholar
Ingram, D L, White, S T, Lyna, P Ret al. (1992). Gardnerella vaginalis infection and sexual contact in female children. Child Abuse Negl 16, 847–853CrossRefGoogle ScholarPubMed
*Jaquiery, A, Stylianopoulos, A, Hogg, G, Grover, S (1999). Vulvovaginitis: clinical features, aetiology and microbiology of the genital tract. Arch Dis Child 81, 64–67CrossRefGoogle ScholarPubMed
Jensen, I P, Thorson, P, Müller, B R (1997). Sensitivity of ligase chain reaction assay of urine from pregnant women for Chlamydia trachomatis. Lancet 349, 329–330CrossRefGoogle ScholarPubMed
Jones, R (1996). Childhood vulvovaginitis and vaginal discharge in general practice. Fam Pract 13, 369–372CrossRefGoogle ScholarPubMed
Kristensen, G B, Bollerup, A C, Lind, Ket al. (1985). Infections with Neisseria gonorrhoea and Chlamydia trachomatis in women with acute salpingitis. Genitourin Med 61, 179–184Google ScholarPubMed
Lamont, R F, Morgan, D J, Wilden, S D, Taylor-Robinson, D (2000). Prevalence of bacterial vaginosis in women attending one of three general practices for routine cervical cytology. Int J STD AIDS, 11, 495–498CrossRefGoogle ScholarPubMed
MacSween, K F, Ridgway, G L (1998). The laboratory investigation of vaginal discharge. J Clin Path 51, 564–567CrossRefGoogle Scholar
Masfari, A N, Duerden, B I, Kinghorn, G R (1986). Quantitative studies of vaginal bacteria. Genitourin Med 62, 256–263Google ScholarPubMed
McCormack, W M (1994). Pelvic inflammatory disease. N Engl J Med 330, 115–119CrossRefGoogle ScholarPubMed
Minkowski, W L, Baker, C J, Alleyne, D, Baghai, M, Friedlander, L, Schultz, B (1983). Single oral dose metronidazole therapy for Gardnerella vaginalis vaginitis in adolescent females. J Adolesc Health Care 4, 113–116CrossRefGoogle ScholarPubMed
Mogielnicki, N P, Schwartzman, J D, Elliott, J A (2000). Perineal group A streptococcal disease in a pediatric practice. Pediatrics 106, 276–281CrossRefGoogle Scholar
Moraes, P S A (1998). Allergic vulvovaginitis induced by house dust mites: a case report. J Allergy Clin Immunol 101, 557–558CrossRefGoogle ScholarPubMed
Moran, J S, Levine, W C (1995). Drugs of choice for the treatment of uncomplicated gonococcal infections. Clin Infect Dis 20(Suppl. 1), S47–S65CrossRefGoogle ScholarPubMed
Murphy, T V, Nelson, J D (1979). Shigella vaginitis: report of 38 patients and review of the literature. Pediatrics 63, 511–516Google ScholarPubMed
Murray P R (1999). Human Microbiota. In. Topley and Wilson's Microbiology and Microbial Infections, 9th edn, Collier L, Balows A, Sussman M, eds., Vol. 2: Systematic Bacteriology, Balow A, Duerden B I eds., pp. 295–306. Arnold, London
Nugent, R P, Krohn, M A, Hillier, S L (1991). Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29, 297–301Google ScholarPubMed
Nyirjesy, P, Weitz, M V, Gelone, S P, Fekete, T (1995). Paromomycin for nitromidazole-resistant trichomoniasis. Lancet 346, 1110CrossRefGoogle Scholar
Oriel, D, Partridge, B M, Denny, M J, Coleman, J C (1972). Genital yeast infections. Br Med J 4, 761–764CrossRefGoogle ScholarPubMed
Oriel, J D (1988). Anogenital papillomavirus infection in children. Br Med J 296, 1484–1485CrossRefGoogle ScholarPubMed
Oriel J D, Ridgway G L (1982). Neonatal infection. In Genital Infection by Chlamydia trachomatis, pp. 68–73. Arnold, London
Osser, S, Persson, K (1982). Epidemiologic and serodiagnostic aspects of Chlamydial salpingitis. Obstet Gynecol 59, 206–209Google ScholarPubMed
Östergaard, L, Müller, J K, Andersen, B, Olesen, F (1996). Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study. Br Med J 313, 1186–1189CrossRefGoogle ScholarPubMed
Paradise, J E, Campos, J M, Friedman, H M, Frishmuth, G (1982). Vulvovaginitis in premenarcheal girls: clinical features and diagnostic evaluation. Pediatrics 70, 193–198Google ScholarPubMed
Perone, N (1997). Rare urogenital anomaly causing discharge and pain. A case report. J Reprod Med 42, 593–596Google ScholarPubMed
Pierce, A M, Hart, C A (1992). Vulvovaginitis: causes and management. Arch Dis Child 67, 509–512CrossRefGoogle ScholarPubMed
Poch, F, Levin, D, Levin, S, Dan, M (1996). Modified thioglycolate medium: a simple and reliable means for detecting Trichomonas vaginalis. J Clin Microbiol 34, 2630–2631Google Scholar
Pokorny, S F (1992). Prepubertal vulvovaginopathies. Obstet Gynecol Clin North Am 19, 39–58Google ScholarPubMed
Powell, J, Wojnarowska, F (2000). Childhood vulval lichen sclerosis and sexual abuse are not mutually exclusive diagnoses. Br Med J 320, 311CrossRefGoogle Scholar
Redmond, A O (1997). Risk—benefit experience of ciprofloxacin use in pediatric patients in the United Kingdom. Pediatr Infect Dis J 16, 147–149CrossRefGoogle ScholarPubMed
Rettig, P J, Nelson, J D (1981). Genital tract infection with Chlamydia trachomatis in prepubertal children. J Pediatr 99, 206–210CrossRefGoogle ScholarPubMed
Rettig, P J, Nelson, J D, Kusmiesz, H (1980). Spectinomycin therapy for gonorrhoea in prepubertal children. Am J Dis Child 134, 359–363Google ScholarPubMed
Ridgway, G L (1986). Chlamydial infections in man. Postgrad Med J 62, 249–253CrossRefGoogle ScholarPubMed
Ridgway, G L (1997). Treatment of chlamydial genital infection. J Antimicrob Chemother 40, 311–314CrossRefGoogle ScholarPubMed
Ris, H W (1978). Nonvenereal transmission of gonococcal vaginitis. Pediatrics 61, 144–145Google ScholarPubMed
Robinson, A J, Watkeys, J E M, Ridgway, G L (1998). Sexually transmitted organisms in sexually abused children. Arch Dis Child 79, 356–358CrossRefGoogle ScholarPubMed
Ross, J D C (2001). Outpatient antibiotics for pelvic inflammatory disease. Br Med J 322, 251–252CrossRefGoogle ScholarPubMed
Royal College of Physicians' Working Party (1997). Physical Signs of Sexual Abuse in Children, 2nd edn. RCP, London
Sanders, D Y, Wasilauskas, B L (1973). Shigella vaginitis. clinical notes on two childhood cases. Clin Pediatr 12, 54–55CrossRefGoogle ScholarPubMed
Scholes, D, Stergachis, A, Heidrich, F E, Andrilla, H, Holmes, K K, Stamm, W E (1996). Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 334, 1362–1366CrossRefGoogle ScholarPubMed
See, W A, Mayo, M (1991). Ectopic ureter: a rare cause of purulent vaginal discharge. Obstet Gynecol 78, 552–555Google ScholarPubMed
Shahlaee, A H, Burton, E M, Sabio, H, Plouffe, L, Teeslink, R (1997). Primary chylous vaginal discharge in a 9-year-old girl: CT-lymphangiogram and MR appearance. Pediatr Radiol 27, 755–757CrossRefGoogle Scholar
Shapiro, R A, Schubert, C J, Siegel, R M (1999). Neisseria gonorrheae infections in girls younger than 12 years of age evaluated for vaginitis. Pediatrics 104, e72, 1378CrossRefGoogle ScholarPubMed
Shore, W B, Winkelstein, J A (1971). Nonvenereal transmission of gonococcal infections to children. J Pediatr 79, 661–663CrossRefGoogle Scholar
Siegel, R M, Schubert, C J, Myers, P A, Shapiro, R A (1995). The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: rationale for limited STD testing in prepubertal girls. Pediatrics 96, 1090–1094Google ScholarPubMed
Southgate, L, Treharne, J, Williams, R (1989). Detection, treatment and follow up of women with Chlamydia trachomatis infection seeking abortion in inner city general practices. Br Med J 299, 1136–1137CrossRefGoogle ScholarPubMed
Steele, A M, San Lazaro, C (1994). Transhymenal cultures for sexually transmissible organisms. Arch Dis Child 71, 423–427CrossRefGoogle ScholarPubMed
Stenberg, K, Mårdh, P-A (1986). Persistent neonatal chlamydial infection in a 6-year-old girl. Lancet , 1278–1279CrossRefGoogle Scholar
Stokes, T (1997). Screening for Chlamydia in general practice: a literature review and summary of the evidence. J Public Health Med 19, 222–232CrossRefGoogle Scholar
Straumanis, J P, Bocchini, J A (1990). Group A beta-haemolytic streptococcal vulvovaginitis in prepubertal girls: a case report and review of the past twenty years. Pediatr Infect Dis J 9, 845–848CrossRefGoogle Scholar
Thompson, C, Macdonald, M, Sutherland, S (2001). A family cluster of Chlamydia trachomatis infection. Br Med J 322, 1473–1474CrossRefGoogle ScholarPubMed
Vandeven, A M, Emans, S J (1993). Vulvovaginitis in the child and adolescent. Pediatr Rev 14, 141–147CrossRefGoogle ScholarPubMed
Waghorn, D J, Tucker, P K, Chia, Y, Spencer, S, Luzzi, G A (1998). Collaborative approach to improve the detection and management of trichomoniasis in a low prevalence district. Int J STD AIDS 9, 164–167CrossRefGoogle Scholar
Waites, K B, Brown, M B, Stagno, S et al. (1983). Association of genital mycoplasmas with exudative vaginitis in a 10 year old: a case of misdiagnosis. Pediatrics 71, 250–252Google Scholar
Wald, E R (1984). Gynecologic infections in the pediatric age group. Pediatr Infect Dis 3(Suppl. 3), S10–S13CrossRefGoogle ScholarPubMed
Walker, C K, Kahn, J G, Washington, A E, Peterson, H B, Sweet, R L (1993). Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy. J Infect Dis 168, 969–978CrossRefGoogle ScholarPubMed
Watkins, S, Quan, L (1984). Vulvovaginitis caused by Yersinia enterocolitica. Pediatr Infect Dis 3, 444–445CrossRefGoogle ScholarPubMed
Webb, A M C, Chandioc, S (1989). Chlamydia trachomatis infection. Br Med J 299, 1527Google Scholar
Weström, L, Svensson, L, W⊘lner-Hansen, P, Mårdh, P-A (1982). Chlamydial and gonococcal infections in a defined population of women. Scand J Infect Dis Suppl 32, 157–162Google Scholar
Whittington, M J (1957). Epidemiology of infections with Trichomonas vaginalis in the light of improved diagnostic methods. Br J Vener Dis 33, 80–88Google ScholarPubMed
Wood, P L, Bevan, T (1999). Child sexual abuse enquiries and unrecognised vulval sclerosus et atrophicus. Br Med J 319, 899–900CrossRefGoogle ScholarPubMed
Working Group of the British Society for Medical Mycology (1995). Management of genital candidiasis. Br Med J 310, 1241–1244CrossRef
Zelikovski, A, Mimouni, M, Shuper, A, Haddad, M, Zer, M (1989). Primary chylocolporrhea successfully managed by division and ligation of retroperitoneal lymphatics. Lymphology 22, 132–134Google ScholarPubMed

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