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STIs in Children When Sexual Abuse Is Suspected

Comprehensive testing is important in such children. Nucleic acid amplification tests on urine specimens were more sensitive than culture for detecting C. trachomatis and N. gonorrhoeae.

Two studies provide a wealth of information about testing for sexually transmitted infections (STIs) in children who are possible victims of sexual abuse. The first study examined the epidemiology of STIs in 485 girls (age range, 2 months to 13 years) who were tested for STIs at four U.S. clinics because of suspected sexual abuse. In a second study, the authors used the same data to examine the accuracy of nucleic acid amplification tests (NAATs) using urine and genital swabs compared with culture for detecting STIs. NAAT results were confirmed by PCR.

The prevalence of a positive result from any test (culture, urine NAAT, or vaginal NAAT) was 3.1% for Chlamydia trachomatis and 3.3% for Neisseria gonorrhoeae. Among 384 children who underwent serologic testing, 1 child had evidence of syphilis and none had evidence of HIV infection. Herpes simplex virus was identified by serology in 2.5% of 283 children tested, and Trichomonas vaginalis was identified by wet mount in 5.9% of 85 girls tested. Although girls with vaginal discharge were significantly more likely to have an STI than those without discharge (24.5% vs. 6.3%), 10 girls with STIs had normal physical exams.

Among the 15 girls with evidence of C. trachomatis, 7 had positive cultures, 13 had positive urine NAATs, and 11 had positive vaginal NAATs. Among the 16 girls with evidence of N. gonorrhoeae, 12 had positive cultures, 14 had positive urine NAATs, and 14 had positive vaginal NAATs. All girls with a positive vaginal culture for C. trachomatis or N. gonorrhoeae had a positive urine or vaginal NAAT. Two girls had positive rectal swab specimens for C. trachomatis but negative vaginal swab specimens by culture and NAAT. Eight girls with positive NAATs for C. trachomatis and four with positive NAATs for N. gonorrhoeae had negative cultures.

Comment: When sexual abuse of a child is suspected, comprehensive testing is critical. Because NAAT on urine specimens provides greater sensitivity than culture and is less invasive than swabs, it might become the new forensic standard for diagnosis of C. trachomatis and N. gonorrhoeae infections in children being evaluated for sexual abuse. Before adopting NAAT, physicians should check with local authorities to determine whether NAAT results are accepted as legal proof of infection.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 29, 2009

Citation(s):

Girardet RG et al. Epidemiology of sexually transmitted infections in suspected child victims of sexual assault. Pediatrics 2009 Jul; 124:79.

• Original article (Subscription may be required)
• Medline abstract (Free)

Black CM et al. Multicenter study of nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in children being evaluated for sexual abuse. Pediatr Infect Dis J 2009 Jul; 28:608.

• Medline abstract (Free)