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Case Report
A 9-year-old girl presented to an urgent care clinic with a chief complaint of vaginal pain with vaginal discharge present for 2 days. The discharge was described as thick and yellow, and the patient's mother reported that the patient's underwear was frequently wet with discharge. Additionally, the patient reported a 2week history of a cold, including thick yellow nasal drainage. Shedid not have a fever. She denied any anal symptoms such as pruritis or painful defecation.
The patient and her mother denied any history of vaginal discharge or urinary tract infection. Her medical history was essentially negative; she had one previous hospitalization for pneumonia at the age of 3.
The mother reported that the patient had good personal hygiene, and took daily showers (no baths). There was no history of new soaps or laundry detergents. The mother also stated that the patient wore only cotton undergarments. No suspicion for sexual abuse was raised by the mother, nor were risk factors present.
On physical examination, the patient was afebrile, with normal vital signs. She was 75th percentile for height and just under 50th percentile for weight. A thick green-yellow discharge was noted from both nares. The oropharynx and tonsils were clear, without erythema or exudate. Genitourinary examination was significant for a Tanner stage 2 female (with sparse hair along her labia), with some erythema of the vaginal introitus but no labial erythema. No vaginal discharge was visible on examination, and no discharge was noted in the patient's underwear. The anus showed no signs of infection. Her physical examination was otherwise normal.
Vulvovaginitis was suspected from the history, and swabs of the vaginal introitus were collected. A rapid test for streptococcal antigen was performed on one swab (Acceava Strep A test, Thermo Biostar, Louisville, CO), and was positive for group A [beta]-hemolytic streptococcal antigen. Vaginal swabs were also collected for wet prep and culture. A nasal swab was also sent for culture, and the patient was sent home on a 10-day course of amoxicillin. The wet prep was negative for yeast or trichomonas. Both the vaginal and nasal culture specimens were positive for Group A [beta]-hemolytic Streptococcus (GABHS) (Strepto-coccus pyogenes).
Urinalysis was significant for a specific gravity of 1.025, a pH of 6.5, trace leukoesterase,...