Vulvovaginitis, characterized by inflammation of the vulvar and vaginal areas, is the most common gynecological disease in prepubertal girls and frequently causes great anxiety in children and their parents [
1]. Anatomic, physiological, and behavioral factors associated with prepubescence create favorable conditions for microorganisms to persist and multiply in the vulva and vagina, causing disruption of vaginal microbiota equilibrium. Disorders involving vaginal flora usually cause infectious clinical syndromes with irritating symptoms, such as vaginal discharge, external genital organ erythema, soreness, itch, irritation, dysuria, and bleeding. Identifying and eradicating the causative pathogen have been the typical clinical diagnosis and treatment practices [
2]. Bumbulienė Ž et al. [
3] reported that positive microbiological findings were found in 100% of symptomatic girls and in 60% of healthy girls, and fecal bacteria were isolated from 53% of girls with vulvovaginitis and from 25% of healthy girls.
Escherichia coli,
Enterococcus faecalis, coagulase-negative
Staphylococcus, α-hemolytic
Streptococcus, and group A β-hemolytic
Streptococcus accounted for 66% of all isolated microbes. In another study, Sikanić-Dugić N et al. reported that among 115 prepubertal girls with vulvovaginitis, causative agents were isolated from vaginal cultures in 38 (33%) cases, of which 21 indicated group A β-hemolytic
Streptococcus, 5 indicated
Haemophilus influenzae, 3 indicated
Escherichia coli, 2 indicated
Enterococcus spp., and one each indicated
Staphylococcus aureus,
Proteus mirabilis, and
Streptococcus pneumoniae [
4]. The main problems in the diagnosis and treatment of vulvovaginitis are that some pathogens cannot be isolated by culture, and it is difficult to determine whether bacteria isolated from the patients’ vaginal secretions are the actual cause of the symptoms or are part of the normal flora. In adult women, modern culture-independent technologies have revealed that the vaginal microbiome is a complex and dynamic ecosystem containing more than 200 bacterial species and that normal vaginal microbiota is mainly dominated by
Lactobacilli [
5]. However, there are few studies on the vaginal microflora in prepubertal girls with and without vulvovaginitis, and additional studies are needed to determine the normal and pathogenic vaginal flora in prepubertal girls [
1].
In the present study, we focused on two questions: (i) What are the characteristics of the vaginal microbiome in healthy prepubertal girls? (ii) What are the differences in vaginal microbiome between healthy prepubertal girls and prepubertal girls with vulvovaginitis?