Sexually transmitted diseases in children: non viral including bacterial vaginosis, Gardnerella vaginalis, mycoplasmas, Trichomonas vaginalis, Candida albicans, scabies and pubic lice.

There are important anatomical and physiological differences between the genital organs of adults and children. In a child the vulva is located more anteriorly than the adult with the clitoris, labia minora and hymen relatively more prominent. The vagina has a shallow posterior fornix and is of comparatively greater length than in the adult. The cervix is tiny with few glands and is rarely a source of leucorrhoea. The vulva lacks the characteristic protection of subcutaneous fat and hair present in the adult. At birth the presence of maternal oestrogens produces transient vulval and hymenal engorgement with a thickened glycogen-rich epithelium and a consequent physiological leucorrhoea. The vaginal epithelium thins and the glycogen disappears; thus the introital area is normally redder in young girls because only this thin epithelium overlies the vascular stroma.1 The vulva is delicate and sensitive, easily traumatised by physical injury and susceptible to infection.2 Disruption of the epithelial integrity from whatever cause may permit colonisation or opportunistic infection by any potential pathogen. With the approach of puberty, endogenous oestrogen is produced and the epithelium thickens and contains glycogen. The pre-menarcheal cervix secretes mucus from the columnar epithelium under oestrogenic influence. These differences will influence the microbiological flora of the genital tract, and therefore the microorganisms which can be considered potentially normal and those that are potentially pathogenic.