The clitoris is a highly complex organ whose structure has only been clarified in recent years through the use of modern imaging techniques. Clitoromegaly is an abnormal enlargement of this organ. It may be congenital or acquired and is usually due to an excess of androgens in fetal life, infancy, or adolescence. Obvious clitoromegaly in individuals with ambiguous genitalia is easily identifiable, whereas borderline conditions can pass unnoticed. Case reports of clitoromegaly with or without clinical or biochemical hyperandrogenism are quite numerous. In these subjects, a comprehensive physical examination and an accurate personal and family history are needed to investigate the enlargement. We reviewed the literature on the conditions that may be involved in the development of clitoromegaly in childhood and adolescence.

Congenital cytomegalovirus (CMV) infection is the most common congenital infection in the world with approximately 0.5-2% of all live born infants, and can cause early or late severe neurological and neurisensorial damage. Although no drug has been licensed for therapy of congenital CMV infection, ganciclovir (GCV) and its oral pro-drug, valganciclovir (val-GCV), is increasingly being administrated to symptomatic infants, to improve neurodevelopmental and auditory outcome. Other potentially efficacious for therapy of congenital CMV disease are foscarnet and cidofovir, which have only been administered in few cases. A literature search was performed to look for evidence based or scientific articles evaluating pharmacokinetics, efficacy, and side effects of GCV/val-GCVand the other two anti-viral drugs.

Background After a primary maternal CMV infection during pregnancy infants are at risk for disease. Methods Factors predictive of infant outcome were analyzed in a database of 304 pregnant women with a primary infection. These were enrolled between 2010 and 2017 and delivered 281 infants, of whom 108 were CMV infected. Long term follow-up occurred for 173 uninfected and 106 infected infants at age 4 years (range 1 to 8 years). 157 women were treated with an average of 2 doses (range 1 to 6) of high dose hyperimmune globulin (HIG: 200 mg/kg/infusion). We used a regression model to define predictors of fetal infection, symptoms at birth, and long-term sequelae. 31 covariates were tested. Results Four factors predicted fetal infection: a 1.8 fold increase (30% vs. 56%) in the rate of congenital infection without HIG (P<0.0001, adjusted odd ratio (AOR) =5.2), a 1.8 fold increase (32% vs. 56%) associated with maternal viral DNAemia prior to HIG administration (P=0.002, AOR=3.0), abnormal ultrasounds (P=0.0002, AOR=54.2), and diagnosis of maternal infection via seroconversion rather than avidity (P=0.007, AOR=3.3). Lack of HIG and abnormal ultrasounds also predicted symptoms (P=0.001). Long term sequelae were predicted by not receiving HIG (P=0.001, AOR=13.2), maternal infection in early gestation (P=0.017, OR = 0.9), and abnormal ultrasounds (P<0.003, OR =7.6). Prevalence and copy/number of DNAemia declined after HIG. Conclusions Maternal viremia predicts fetal infection and neonatal outcome. This may help patient counseling. High-dose HIG may prevent fetal infection and disease, and is associated with the resolution of DNAemia.