Gonococcal Vulvovaginitis in Infants

Gonorrhoea in women often produs mior symptoms. This explains the comparative infrequency of symptomatic gonorrhoea of the lower genital tract in out-patient clinics. Gonococcal infection of infants and children, on the other hand, at once attracts attention. Hence the reason why the incdence of vulvovaginitis infantum appears to be comparatively high. Nelson (1932) found the incidence of gonorrhoeal vulvovaginitis to be 11-8% and Mukherjee (1940) 11%. In a sernes of 2,464 cases in the female, diagnosed by bacteriological methods during 1933-46, we came across 240 cases of gonorrhoeal vulvovagitis, a frequency of 9-7%. Not all cases of vulvovaginitis are caused by gonorrhoea. Foreign bodies, non-specific infections caused by unhygienic conditions, threadworms, exanthematous fevers, monilia, and diphtheria account for a fair number. Fessler (1930) found gonorrhoea in two out of 25 cases, and Clauberg (1930) failed to cultivate the gonococcus from 70 children examined for the condition. Ruys (1935) found gonococci in 57 out of 292 children. During the period under review the total number of vulvovaginitis cases was 438, of which 240 (55%) were diagnosed as gonorrhoeal. This may appear to be high and is probably so, for most patients with simple catarrhal vaginitis do not report to hospitals for invesfigation and treatment. It may be of interest to compare the relative frequency of gonorrhoea with the other aetiological conditions causing vulvovaginitis in children (Table 1). The incidence of gonococcal infection in any study of vulvovaginitis is dependent on the meam employed for the detection of gonococci. The unreliability of smear examination alone has been shown by several observers (Clauberg, 1930; Ruys, 1935). This is because of the presence of Gram-negative cocci, which are often arranged in pairs, in the norm valgina. Grenhill (1945) suggested that to identify gonococci one must TABLE 1 COMPARISON oF AETmLoGIcAL CoNDnwrn CAUSING VULVOVAGPNTM