TemplateVulvovaginitisTap a choice or type a Repertoire Line to see how the note changes. Defaults are what the template inserts on its own.Try a Repertoire Linevulvovaginitisvaginal itching: pinworm cause, tape testvulvovaginitis: strep rash, strep positivevaginal redness: candidal, sitz bathsvulvar irritation: discharge, gynecology referral, no abuse concernvulvovaginitis: bleedingvulvovaginitis: vaginal foreign bodyPractice wording only: leave out patient details. Nothing typed here is saved or sent. Practice a case insteadLikely causeChoose oneNonspecific vulvovaginitis from irritation, the most common cause before pubertyDefaultPerianal and vulvar itching at night concerning for pinwormsBright red vulvar or perianal rash concerning for group A strepCandidal rash with satellite lesionsBloody dischargeFoul or bloody discharge concerning for a vaginal foreign bodyExternal exam presentChoose anydischargebleedinglesionsExternal exam absentChoose anydischargeDefaultbleedingDefaultlesionsDefaultUrinalysisChoose oneUA deferred after shared decision making with family given history and examDefaultUA negativeUA not needed given the cause found on examTestingChoose anyRapid strep test of the vulvar or perianal area sentVaginal culture sentTape test for pinworms on waking recommendedTreatmentChoose oneStarted Amoxicillin given a positive strep testRecommended pyrantel pamoate for pinworms, repeated in 2 weeks, with household treatment discussedRecommended clotrimazole cream for the candidal rashHygieneChoose anyavoiding bubble baths and scented soapsDefaultcotton underwear and loose clothingDefaultfront-to-back wiping and voiding with knees apartDefaultdrinking plenty of waterDefaultdaily plain warm water soakschanging out of wet swimsuits promptlyAbuse screeningChoose oneNo concern for sexual abuse on history or examReport made to child protective services and referral to a child abuse specialist given concern for sexual abuseSTI testingChoose anyTesting for sexually transmitted infections sentReferralChoose oneReferred to pediatric gynecology given symptoms not improving with hygiene measuresReferred to pediatric gynecology given concern for a vaginal foreign bodyFollow-upChoose onein 2 weeks if not improvingDefaultafter the specialist visitas neededCounseling paragraphChoose oneParagraphVulvar irritation is common before puberty because the skin is thin and sensitive, and it usually improves over 1 to 2 weeks with gentle care. Recommended supportive care with an emphasis on plain warm water soaks, gentle drying, cotton underwear, and avoiding bubble baths and scented products. Return precautions given including pain with urination, fever, bloody or foul-smelling discharge, increasing redness or swelling, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.DefaultPinworms cause itching that is worse at night and spread easily within families. Recommended supportive care with an emphasis on plain warm water soaks, gentle drying, cotton underwear, and avoiding bubble baths and scented products. Handwashing, short fingernails, and washing bedding and underwear help prevent reinfection. Return precautions given including pain with urination, fever, bloody or foul-smelling discharge, increasing redness or swelling, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.Strep infection of the vulvar skin improves within a few days of antibiotics. Recommended supportive care with an emphasis on plain warm water soaks, gentle drying, cotton underwear, and avoiding bubble baths and scented products. Return precautions given including pain with urination, fever, bloody or foul-smelling discharge, increasing redness or swelling, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.A yeast rash improves over several days with the cream and keeping the area dry. Recommended supportive care with an emphasis on plain warm water soaks, gentle drying, cotton underwear, and avoiding bubble baths and scented products. Return precautions given including pain with urination, fever, bloody or foul-smelling discharge, increasing redness or swelling, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.Bloody or foul discharge needs a closer look; a small piece of toilet paper is a common cause and the discharge stops once it is removed. Recommended supportive care with an emphasis on plain warm water soaks, gentle drying, cotton underwear, and avoiding bubble baths and scented products. Return precautions given including pain with urination, fever, bloody or foul-smelling discharge, increasing redness or swelling, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.What the sources coverCause: nonspecific, pinworms, group A strep, candida, foreign bodyGAS swab; pinworm tape testAmoxicillin for GAS; pyrantel for pinworms; clotrimazole for candidaHygiene: bubble baths, cotton, wiping, water; soaksSexual abuse screeningGynecology referral (persistent; foreign body)Paragraph per causeReturn precautions in the templatepain with urinationfeverbloody or foul-smelling dischargeincreasing redness or swellingSourcesPediatric Care Online: Vaginal DischargeRed Book 2024-2027: Group A Streptococcal InfectionsFew formal guidelines cover this topic, so the template also leans on expert opinion.