Streptococcal vulvovaginitis is inflammation of the vulvar and/or vaginal tissue caused primarily by infection with the gram-positive bacterium Streptococcus pyogenes or Lancefield group A β-hemolytic streptococci (GAS). It is mostly seen in the pediatric population, specifically in the prepubertal age group, between the ages of 2 and 12 years, with a peak between the ages of 3 and 7 years. In this population, vulvovaginitis is one of the most common gynecologic concerns, and infectious vulvovaginitis causes one-third of cases. GAS is one of the leading causes of infectious vulvovaginitis, accounting for 8%-47% of cases, with the other common pathogens being Haemophilus influenzae and Enterobius vermicularis (pinworm). Vulvovaginal infections may result from prior respiratory or skin sources, as GAS is well-known to cause pharyngitis and impetigo in school-age youth, and 5%-11% of healthy people are colonized in their upper respiratory tracts. In the prepubescent population, the infection typically starts at the vulva and spreads to the vagina. Most infections are due to anatomic factors (eg, thinner vulvovaginal mucosa, decreased labial fat pads, neutral pH, limited local immunity, proximity to the anus) or behavioral factors (eg, poor hygiene or exposure to irritants).

Streptococcal vulvovaginitis is exceedingly rare in adults, given that GAS colonization of the female genital tract is far less prevalent, with rectovaginal cultures of a large cohort study of 6944 pregnant women showing only 0.03% GAS positivity versus 20.1% group B Streptococcus positivity. Reports of streptococcal vulvovaginitis in adult females have primarily been in those with risk factors such as postmenopausal or lactational status, sexual exposure, and/or personal or household history of GAS skin or respiratory infection. Similar to the pediatric population, in many of the reported cases of streptococcal vulvovaginitis, there was a history of recent GAS pharyngitis or skin infection in either the patient or a close contact.

Infections occur acutely and symptoms are typically severe. Reported symptoms include acute-onset vulvovaginal pain, burning, irritation, pruritus, tenderness, soreness, dysuria, excoriations, bleeding, and dyspareunia.