Association between Shigella flexneri and the presence of vulvovaginal microulcerations in prepubertal Peruvian girls with specific vulvovaginitis: a cross-sectional study

Abstract

Background: Vulvovaginitis is one of the main reasons for gynecological consultation in prepubertal girls. It is not common for bacteria of the Shigella genus to be the cause, but cases with typical lesions with microulcerations have been reported. Objective: To find an association between Shigella flexneri infection and the presence of vestibulovaginal microulcerations in prepubertal girls who attended the National Institute of Child Health (INSN) between December 2008 and November 2009. Materials and methods: An observational, analytical and cross-sectional study was carried out that evaluated a sample of 149 girls from 0 to 9 years of age through systematic sampling. Inclusion criteria included patients with specific vulvovaginitis and findings of microulcerations; and those who did not have the infection. Bivariate tests such as chi-square, Fisher’s exact test were used; In addition, measures of association were calculated using generalized linear models. Results: Of the total number of patients, it was found that 56.5% tested positive for Shigela flexneri and 48.9% presented microulcerations and, of the latter, 95.8% presented bloody discharge (p<0.001). Likewise, an association was found between the presence of microulcerations and a positive culture for Shigella flexneri (p<0.001) and in the same way when the comparison was made with other Shigella species (p<0.001); these significant differences were lost in multivariate analysis. A strong association was found between the presence of bloody discharge and the presence of microulcerations (PR=17.84; 95% CI: 5.21-61-05; p<0.001). Conclusion: There is an association between a positive culture for Shigella flexneri and the presence of vestibulovaginal microulcerations in prepubertal girls.