she is a 9 yrs old girl. has these lesions over her vulva n around anus for 7-10 days. dese r very itchy lesions. bt not painfull. she has no history of such lesions in past n no h/o burning micturition or vaginal discharge. she has taken treatment for fungal infection bt didnt get any relief in itchh or lesions improvement. no family history of such lesions. no history of oral herpes to her or family. (Note: i hv taken d photos aftr permission of her parents n in presence of my nurse attendent) dd n tt???

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Lesions look like Candidiasis with secondary bacterial infection due to itching . But to establish that , first rule out any H / O sexual abuse. History does not always elicit the facts. Advice : - Swabs from lesions for : 1 ) Gram's stain and Giemsa stain, 2 ) KOH Preparation and fungal culture 3 ) NAT test for HSV1 and 2 ; Human Herpes Virus (HHV TYPE - 1 and 2 ). Though HHV TYPE 1 rarely causes genital Herpes. RX :- 1 ) Topical Antibiotics + Antifungal cream 2 ) Oral antibiotics of choices 3 ) Oral antihistamines of choice. 4 ) Maintenance of good personal and local hygiene.

Looks like candidial infection with sec bacterial infection due to itching. Anti allergic with antibacterial and antifungal cream to be given with oral antibiotics. Also rule out H/O any sexual abuse.

Rule out sexual abuse first.then give oral antibiotcs, local antibiotcs antfungal cream. Thorough cleaning with saline. Give anti histaminic.

R/O Sexual abuse and Herpes.It looks like herpes with sec.infection.Give her oral antibiotics,antifungal treatment nd Acyclovir cream for local vulval application .

Scrutinize with confidence h/o sexual abuse Hypertrophy of Clitoris + fungo-bacterial infection Oral Antibiotics Antihistamines Antifungal Anti inflammatory Local Gention Violet

??? Sexual abuse ??? Habits of playing with Clitoral hypertrophic??? Candida infection Secondary skin infection Antibiotic ointment locally Antibiotic and antifungal orally Hygiene Use dry n cotton inner clothing ??? Enuresis

Dx : FUNGAL INFECTION WITH SECONDARY BACTERIAL INFECTION. CLITORAL HYPERTROHY ++. NEEDS GYNECOLOGY OPINION TOO.

Candidial vulvitis with sec bacterial infection, recurrent itching causing spreading of lesions... Rx accordingly with deworming appropriately,local antifungal with antibacterial , antiallergic orally with maintain hyegiene. We have to rule out herpes genitalia. May need antiviral orally for 7 to 10days see for recurrence. follow at frequent intervals

Hypertrophic Clitoris with fungal infection. ...rule out sexual abuse

To add on what has been said 1.ensure patient hygiene 2.use sitz bath with dettol 3.analgesic As it seems She has chronic fungal and bacterial infection and Her clitoris has enlarged due to inflammation of the surrounding tissues.

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