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Estrogen vs. Conservative Therapy for Labial Agglutination in Prepubertal Girls
208
Poster Abstracts / J Pediatr Adolesc Gynecol 29 (2016) 188e210
Table 2 Comparison of Side Effects Between LARC methods All Teen LARC Users N¼1005
LNG IUD Copper IUD ENG Implant
Teen LARC Users Reporting Side Effects N¼394
N (%)
N (%)
445 (44.3) 75 (7.5) 485 (48.3)
167 (42.4) 25 (6.4) 202 (51.3)
additional information to frame expectations for teens when counseling regarding common side effects of LARC methods and may help to promote the use and continuation of LARC among at-risk teens. 92. Abnormal Presentation of Early Syphilis as Dyspareunia in Adolescent Female Jane Geyer MSN, WHNP, Jennifer E. Dietrich MD, MSc* Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
Background: Syphilis (SP) is a sexually transmitted infection caused by the spirochete Treponema pallidum and has 4 distinguishable stages once acquired (primary, secondary, latent and tertiary). Primary SP normally presents with a painless, indurated genital ulcer at site of inoculation, 9-90 days after exposure to the disease. It is usually accompanied by non-tender inguinal nodes. There have been few case reports on atypical presentation of primary SP, including an erythematous nodule on the nipple and tonsillar chancres. An adolescent female presented to our clinic with symptoms of dyspareunia that had been an ongoing condition. Case: An 18 year old female with past medical history of Factor V Leiden who presented with an eight month history of an internal and external burning sensation during intercourse. She had been sexually active for 10 months, with the same male partner (her only lifetime partner). She noted the burning sensation with every act of intercourse and the sensation persists for up to 45 minutes post-intercourse (2-3 times/week). She had been treated for bacterial vaginosis with a course of Flagyl 8 months prior. Sureswab was negative for BV at this visit. She was doing well with her levonogestrel IUD. After screening patient for sexually transmitted infections, only her RPR returned reactive. A confirmatory FTA ab test came back as reactive with 1:1 titer, concluding the patient was in the early phase of a SP. Although she showed no signs of a genital chancre or any other clinical symptoms that would indicate a SP infection, she was treated with Penicillin G injection and referred to infectious disease. Comments: It is possible that early SP can present as dyspareunia and without any signs of a genital ulcer. There currently are not any case reports noting a similar presentation. With SP outbreaks back on the rise, it is important that clinicians consider the infection even in the setting of atypical presentation.
93. Estrogen vs. Conservative Therapy for Labial Agglutination in Prepubertal Girls
% of Users Reporting Side Effects per LARC Method
P value For Difference in Reported Side Effects by Method
37.5 33.3 41.6
0.54 0.54 0.54
conservative treatment were reviewed to date. The treatment group received topical estrogen in the form of conjugated equine estrogen. Estrogen was prescribed in a variable manner at the discretion of the physician. Duration of treatment varied from “as needed” to 3 months. The other group received conservative therapy, more specifically education regarding vulvar hygiene. Results: To date, 200 patients have been reviewed, 100 of which who were given topical estrogen therapy and 100 who were treated conservatively. Of those who were given topical estrogen, the mean age of patients was 3.9 years (range: 7 months to 12 years) as compared to 3.1 years (range: 7 months to 8 years) in the conservative group. 39% of the treatment group was symptomatic with irritation, redness, or urinary symptoms, compared to 20% of the conservative group. Severe labial agglutination was defined as greater than two-thirds fused and was seen in 67% of the treatment group, compared to 38% of the conservative group. 79/100 of the estrogen treatment group was followed after their initial consult as compared to 26/100 of the girls with conservative treatment. 35 patients with no treatment were discharged after the first visit and the rest were lost to follow-up. The median time the patients were followed in the clinic was 167 days for those with estrogen therapy and 105 days for those without therapy. Thirty-two patients (40%) in the estrogen arm had complete resolution of their labial agglutination and another 32 patients (40%) experienced improvements of their labial agglutination. The rest of the cohort (15/79) did not experience any improvement. With respect to the conservative treatment group, 9 out of the 26 that were followed experienced complete resolution (35%) and 11 (42%) had some improvements. The remaining 6 patients (23%) did not see any improvement. Conclusion: Labial agglutination is a relatively common condition in prepubescent girls. The guidelines for managing patients remain unclear. In this retrospective analysis patients who are more severely fused and symptomatic tended to receive estrogen therapy. Interestingly, the resolution rate and improvement rates of both treatment and no treatment to date appear comparable. Once full data collection has been completed, our intention is to use appropriate statistics to further compare variables between the cohorts of patients who received treatment vs. those who received conservative management only.
94. Rhabdomyolysis Presenting as Unilateral Labial Swelling in an Adolescent Girl Naima Khamsi MD, Carmen Patricia Rojas-Mendez MD, Sireesha Reddy MD, Melissa D. Mendez MD*
Jasmine Multani BSc, Dr. Sari Kives MD, MSc (FRCSC), Dr. Lisa Allen MD (FRCSC)
Texas Tech HSC at El Paso, Paul L. Foster SOM, Department of OB/GYN, El Paso, Texas
Background: The purpose of this study was to assess patient demographics, clinical presentation, and success rate in response to conservative management or estrogen treatment in prepubertal girls referred to a tertiary care center with a diagnosis of labial agglutination. Methods: A retrospective chart review was performed in all girls with labial agglutination treated at a pediatric and adolescent gynecology clinic between 2004 e 2014. Data was collected on the demographics of patients, severity of the labial agglutination, presenting symptomatology, type and length of treatment, and time to resolution (if any) of the labial adhesion. 435 patients were identified that met study criteria. One hundred charts of patients with treatment intervention and 100 charts of those with
Background: Rhabdomyolysis is a clinical syndrome caused by physical or metabolic skeletal muscle injury associated with the development of myoglobinuria and kidney injury. Exertional rhabdomyolysis can be a result of vigorous physical activity and may go undiagnosed in the adolescent age group. Elevated creatine kinase and electrolyte imbalances are the hallmarks of diagnosing this condition. Patients generally present with symptoms of muscle pain, weakness, or dark colored urine. Additional symptoms such as fever, nausea, vomiting, or abdominal pain can be present in more severe cases. We report a unique case of rhabdomyolysis presenting as vulvar edema in a young adolescent who had recently taken up mountain biking.
Poster Abstracts / J Pediatr Adolesc Gynecol 29 (2016) 188e210
Table 2 Comparison of Side Effects Between LARC methods All Teen LARC Users N¼1005
LNG IUD Copper IUD ENG Implant
Teen LARC Users Reporting Side Effects N¼394
N (%)
N (%)
445 (44.3) 75 (7.5) 485 (48.3)
167 (42.4) 25 (6.4) 202 (51.3)
additional information to frame expectations for teens when counseling regarding common side effects of LARC methods and may help to promote the use and continuation of LARC among at-risk teens. 92. Abnormal Presentation of Early Syphilis as Dyspareunia in Adolescent Female Jane Geyer MSN, WHNP, Jennifer E. Dietrich MD, MSc* Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
Background: Syphilis (SP) is a sexually transmitted infection caused by the spirochete Treponema pallidum and has 4 distinguishable stages once acquired (primary, secondary, latent and tertiary). Primary SP normally presents with a painless, indurated genital ulcer at site of inoculation, 9-90 days after exposure to the disease. It is usually accompanied by non-tender inguinal nodes. There have been few case reports on atypical presentation of primary SP, including an erythematous nodule on the nipple and tonsillar chancres. An adolescent female presented to our clinic with symptoms of dyspareunia that had been an ongoing condition. Case: An 18 year old female with past medical history of Factor V Leiden who presented with an eight month history of an internal and external burning sensation during intercourse. She had been sexually active for 10 months, with the same male partner (her only lifetime partner). She noted the burning sensation with every act of intercourse and the sensation persists for up to 45 minutes post-intercourse (2-3 times/week). She had been treated for bacterial vaginosis with a course of Flagyl 8 months prior. Sureswab was negative for BV at this visit. She was doing well with her levonogestrel IUD. After screening patient for sexually transmitted infections, only her RPR returned reactive. A confirmatory FTA ab test came back as reactive with 1:1 titer, concluding the patient was in the early phase of a SP. Although she showed no signs of a genital chancre or any other clinical symptoms that would indicate a SP infection, she was treated with Penicillin G injection and referred to infectious disease. Comments: It is possible that early SP can present as dyspareunia and without any signs of a genital ulcer. There currently are not any case reports noting a similar presentation. With SP outbreaks back on the rise, it is important that clinicians consider the infection even in the setting of atypical presentation.
93. Estrogen vs. Conservative Therapy for Labial Agglutination in Prepubertal Girls
% of Users Reporting Side Effects per LARC Method
P value For Difference in Reported Side Effects by Method
37.5 33.3 41.6
0.54 0.54 0.54
conservative treatment were reviewed to date. The treatment group received topical estrogen in the form of conjugated equine estrogen. Estrogen was prescribed in a variable manner at the discretion of the physician. Duration of treatment varied from “as needed” to 3 months. The other group received conservative therapy, more specifically education regarding vulvar hygiene. Results: To date, 200 patients have been reviewed, 100 of which who were given topical estrogen therapy and 100 who were treated conservatively. Of those who were given topical estrogen, the mean age of patients was 3.9 years (range: 7 months to 12 years) as compared to 3.1 years (range: 7 months to 8 years) in the conservative group. 39% of the treatment group was symptomatic with irritation, redness, or urinary symptoms, compared to 20% of the conservative group. Severe labial agglutination was defined as greater than two-thirds fused and was seen in 67% of the treatment group, compared to 38% of the conservative group. 79/100 of the estrogen treatment group was followed after their initial consult as compared to 26/100 of the girls with conservative treatment. 35 patients with no treatment were discharged after the first visit and the rest were lost to follow-up. The median time the patients were followed in the clinic was 167 days for those with estrogen therapy and 105 days for those without therapy. Thirty-two patients (40%) in the estrogen arm had complete resolution of their labial agglutination and another 32 patients (40%) experienced improvements of their labial agglutination. The rest of the cohort (15/79) did not experience any improvement. With respect to the conservative treatment group, 9 out of the 26 that were followed experienced complete resolution (35%) and 11 (42%) had some improvements. The remaining 6 patients (23%) did not see any improvement. Conclusion: Labial agglutination is a relatively common condition in prepubescent girls. The guidelines for managing patients remain unclear. In this retrospective analysis patients who are more severely fused and symptomatic tended to receive estrogen therapy. Interestingly, the resolution rate and improvement rates of both treatment and no treatment to date appear comparable. Once full data collection has been completed, our intention is to use appropriate statistics to further compare variables between the cohorts of patients who received treatment vs. those who received conservative management only.
94. Rhabdomyolysis Presenting as Unilateral Labial Swelling in an Adolescent Girl Naima Khamsi MD, Carmen Patricia Rojas-Mendez MD, Sireesha Reddy MD, Melissa D. Mendez MD*
Jasmine Multani BSc, Dr. Sari Kives MD, MSc (FRCSC), Dr. Lisa Allen MD (FRCSC)
Texas Tech HSC at El Paso, Paul L. Foster SOM, Department of OB/GYN, El Paso, Texas
Background: The purpose of this study was to assess patient demographics, clinical presentation, and success rate in response to conservative management or estrogen treatment in prepubertal girls referred to a tertiary care center with a diagnosis of labial agglutination. Methods: A retrospective chart review was performed in all girls with labial agglutination treated at a pediatric and adolescent gynecology clinic between 2004 e 2014. Data was collected on the demographics of patients, severity of the labial agglutination, presenting symptomatology, type and length of treatment, and time to resolution (if any) of the labial adhesion. 435 patients were identified that met study criteria. One hundred charts of patients with treatment intervention and 100 charts of those with
Background: Rhabdomyolysis is a clinical syndrome caused by physical or metabolic skeletal muscle injury associated with the development of myoglobinuria and kidney injury. Exertional rhabdomyolysis can be a result of vigorous physical activity and may go undiagnosed in the adolescent age group. Elevated creatine kinase and electrolyte imbalances are the hallmarks of diagnosing this condition. Patients generally present with symptoms of muscle pain, weakness, or dark colored urine. Additional symptoms such as fever, nausea, vomiting, or abdominal pain can be present in more severe cases. We report a unique case of rhabdomyolysis presenting as vulvar edema in a young adolescent who had recently taken up mountain biking.