GoodGirl
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The mother of a 5-year-old girl claims that her stepfather may have had inappropriate sexual contact with the girl. Physical examination reveals an intact hymen and no evidence of trauma. A vaginal swab is negative for acid phosphatase and reveals only normal flora. Which of the following organisms was most likely be isolated?
A- Candida
B- Lactobacillus
C- Neisseria
D- Staphylococcus
E- Streptococcus
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| po
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B?
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| SILVER
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B- Lactobacillus
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| GoodGirl
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Try and think again. She is only 5 years old !
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| po
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E?
form-
http://adc.bmj.com/cgi/content/abstract/88/4/324
This retrospective study evaluated the clinical features and findings in bacterial cultures and in microscopic examination of vaginal secretions in 80 prepubertal girls, aged 2–12 years, with vulvovaginitis. Vaginal secretions were obtained directly from the vagina with a sterile catheter carefully inserted into the vagina. Pathogenic bacteria were isolated in 36% of cases. In 59% of these cases the isolated pathogen was group A ß-haemolytic streptococcus. Candida was not found in any of the patients. The finding of leucocytes in vaginal secretions as an indicator for growth of pathogenic bacteria had a sensitivity of 83% and a specificity of 59%. Antimicrobial treatment should therefore be based on bacteriological findings of vaginal secretions and not on the presence of leucocytes alone.
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| po
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cant be,right it is not a normal flora.so what the ans,I give up..
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| GoodGirl
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Anyone else ? Will wait a bit.
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GG,
why isn't it lactobacillus?
now i'm thinking something along the lines of neisseria, but that doesn't sound right either.....
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| GoodGirl
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Bc she is only 5 years old( prepubertal age), and normal vaginal flora at that age is same as on the skin, so it would be D - as for Staphylococcus epidermidis . Same applies for the postmenopausal women.
Child bearing age women : Lactobacillus, Candida, Streptococcus Species.
Sexual abuse : Neisseria , the rest of STD
Isn't Lactobacillus connected to the hormonal level ? At least this is how the Kaplan explains it.
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| po
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got it,thanks.
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ok 
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| bactitech
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One doesn't see Lacto in vaginal cultures until a child goes through puberty. I have seen a few cases of pre-pubertal children with Group A beta streptococci in pure culture. This has GOT to be a nasty infection. We probably wouldn't work up a few colonies of S. aureus, but if it were a large amount of a pure culture, we definitely would. I've seen that in older women.
We don't see that many vaginal cultures in pre-pubertal females because of the difficulty in obtaining a specimen in this age group. They're awful young for stirrups, etc. and I would suppose the moms would have to be reassured as much as the child before a specimen would be obtained.
Normal flora can include Coagulase negative Staphylococci. I suppose you could conceivably have a yeast infection in this age group if the child were diabetic, but that would not be the usual case, unless she ran around in a wet bathing suit all of the time. I know this scenario can cause yeast infections in older females.
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| drduck
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hey what i heard was that girls start developing the vaginal flora by the second day or first week of life....atleast when she is delivered thru vagina....the flora is passed on...
i agree it is very difficult to take smear from children and virgins....
anyway what was the answer??
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| GoodGirl
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Drduck here is the answer :
GoodGirl wrote:
Bc she is only 5 years old( prepubertal age), and normal vaginal flora at that age is same as on the skin, so it would be D - as for Staphylococcus epidermidis . Same applies for the postmenopausal women.
Child bearing age women : Lactobacillus, Candida, Streptococcus Species.
Sexual abuse : Neisseria , the rest of STD
Isn't Lactobacillus connected to the hormonal level ? At least this is how the Kaplan explains it.
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| bactitech
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Yes, I'm sure flora of some sort is passed via the birth canal. Stool cultures on neonates yield a lot of typical gram negative rods almost immediately.
I'm not sure of the mechanisms involved in the development of vaginal flora. All I know is that one doesn't see the Lacto until later on. We see enterics in all age groups, but not in every culture. We usually just mention this on the report, as sometimes I believe it's a hygiene matter and not a cause of infection.
We get vaginal cultures periodically from nursing home patients. These are usually loaded with enterics. We usually work up Pseudomonas aeruginosa if we see this bug (and we do see that a lot in these cultures) and just mention the other enterics as a group. I'm sure these have to do with the fact that these patients are bedridden and hygiene is not good either.
In a genital culture on a post pubertal female we look for these organisms and that's about it:
Group B strep - we use a broth enhancement to look for this organism also.
Yeast - usually C. albicans
GC - only plate for this if a separate GC/Chlamydia probe is not ordered along with it. There are docs that still do not want to use the new probe methodology. I have no idea why, as it is MUCH more sensitive than culture. Please don't be a holdout when you go into practice....
G. vaginalis - It's presence CAN indicate their MAY be bacterial vaginosis going on.
Many places no longer perform routine genital cultures. They do Group B screens from vaginal/rectal swabs via molecular methods (we are doing that on pregnant women now), and rely on the DNA amplification probe methods for GC/Chlamydia detection. Yeast infections can be determined via a gram stain. The gram stain can also be used to determine bacterial vaginosis because of the presence of clue cells and mobiluncus forms. A trained tech can easily read these and they are better for BV detection than culture.
http://www.cdc.gov/std/bv/STDFact-Bacterial-Vagin...
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