A School­age Female Has Had Vulvovaginitis for 2 Months

A school­age female has had vulvovaginitis for 2 months. All cultures and tests
are negative, but the symptoms persist after treatment with both topical antibiotics and oral amoxicillin. What is the next course of action to treat this condition?

A) Estrogen cream at bedtime for 2 to 3 weeks
B) Referral to a pediatric gynecologist for further evaluation
C) Trimethoprim­sulfamethoxazole daily for 1 to 2 months
D) Workup for possible sexual abuse