Screen the Patient's Family in Recurrent Vulvovaginal Strep


Management of patients with recurrent Group A β-hemolytic streptococcal infections should include screening the patient's family and intimate contacts in order to identify and treat bacterial carriers, according to Dr. Jack Sobel and his colleagues.

Dr. Sobel of Wayne State University School of Medicine, Detroit, and his associates described two cases of recurrent vulvovaginal infections in adult women caused by Group A β-hemolytic streptococcus (GAS), a pathogenic organism. GAS vulvovaginitis has rarely been reported in adult women. GAS colonization can occur in the vagina, but is more likely in the nasopharynx, perineum, anus, and skin, the investigators wrote (Clin. Infect. Dis. 2007;44:43–5).

Both women reported a history of recurrent episodes of vulvovaginal Streptococcus pyogenes infections presenting with pruritus, vaginal discharge, and erythema. The infections resolved after antibacterial therapy but recurred in a short time.

Screening of the patients' families showed that the husbands were gastrointestinal/perianal carriers of S. pyogenes. For each couple, bacterial typing showed the index strain and carrier strain to be identical.

Reinfection was hypothesized to occur through sexual transmission or contamination of the sheets and mattress from perianal shedding of S. pyogenes.

Antibacterial treatment was given to the women and their male partners. Following eradication of bacterial carriage in the male partner, vaginitis recurrence was finally resolved.

“Carriage or exposure to a carrier is an important pathogenic factor in recurrent GAS infection, although it is often ignored,” wrote the study authors.

They reported no conflicts of interest.

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