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Group A streptococcus (GAS) vulvitis is very rare but primarily reported in association with vaginitis. An analysis was done to examine the clinical features of GAS vulvitis in adults, its presence with other infected sites, and its relationship with other dermatological disorders.
The medical records and photographs of adult patients with bacteriologically confirmed GAS vulvitis at three private clinics were analyzed. Coexisting sites of infection, related dermatological conditions, and bacteriological results for the husbands of these three patients were also examined.
Nineteen patients with vulvar GAS infections were identified. The vulvar symptoms involved pain (11 cases), pruritus (9), burning (4), and discharge (10). The chief physical feature was bilateral erythema that was primarily located on the labia minora and the inner aspect of the labia majora. This erythema was accompanied with oozing (3), edema (6), or fissures (6). Seventeen patients had a concomitant vaginal infection, which was asymptomatic in seven cases. Anal infections were observed in 9 cases. Ten patients had associated dermatological conditions such as psoriasis (6), lichen sclerosus (2), Paget disease (1), or vitiligo (1). Two of the 3 bacteriological specimens (one each from the throat and penis) taken from the 3 husbands were GAS positive.
It was concluded that in most adult women, GAS vulvitis is accompanied with a vaginal infection, which might be asymptomatic. A bilateral, oozing, and edematous or fissured erythema that involves the vulvar or anovulvar area is also suggestive of GAS vulvitis. The link with psoriasis and the advantage of screening the household members and sexual partners also needs further consideration.
Source: Liegeon AL, Berville S, Wendling-Héraud J, Moyal-Barracco M. Group A Streptococcal Vulvitis in Adult Women: Clinical Features and Association with Psoriasis. J Low Genit Tract Dis. 2019 Oct; 23(4):287-289.