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1: Child Abuse Negl. 1995 Oct;19(10):1303-10. Related Articles, Links: Sexually transmitted diseases in children and evidence of sexual abuse.

Argent AC, Lachman PI, Hanslo D, Bass D.

Department of Pediatrics and Child Health, University of Cape Town, South Africa.

During the period June 1989 to March 1991, laboratory evidence of sexually transmitted diseases (STDs) was found in 107 patients at the Red Cross War Memorial Children's Hospital in Cape Town. Data was available on 96 patients aged 23 months to 14 years (mean 75.9 months). Vaginal discharge was the most frequent presenting symptom (76%), particularly in those less than 5 years of age (90%). Although a history of abuse was not given on presentation in 62%, evidence of abuse was subsequently elicited in 67% of patients. Neisseria gonorrhoeae was the most common sexual pathogen (61 isolates, 8 penicillin resistant), followed by G vaginalis (17 isolates), Trichomonas vaginalis (7 infections), and T pallidum (9 TPHA positive, 5 with VDRL 1:4 or higher). Chlamydia trachomatis was demonstrated by immunofluorescence in 14 children. Multiple STDs were demonstrated in 10 patients. Although evidence of CSA was not found in all patients with STDs it was likely that the vast majority of patients had acquired these infections by CSA. Symptomatic prepubertal children with G vaginalis isolates should be investigated for CSA. Chlamydial immunofluorescence tests did not assist the diagnosis of CSA in children and should not be used, as they have no medicolegal significance.

PIP: This study examines the nature and extent of sexually transmitted diseases related to sexual abuse among patients seeking treatment during June 1989-March 1991 at the Red Cross War Memorial Children's Hospital in Rondebosch, Cape Town, South Africa. 107 patients aged 23-174 months (about 2-15 years of age) were identified by laboratory testing as having a sexually transmitted disease. Analysis pertained to 96 patients. 10 children had multiple infections. 60 patients were assessed after 2-3 months, of whom 20% (12 cases) indicated evidence of child sexual abuse. 47% of the 36 patients who were not followed-up had evidence of child sexual abuse. Age was unrelated to follow-up or sexual abuse. Genital symptoms were evident at the initial visit among 87 patients (91%), of whom 65% had no prior history of abuse. 26% had a history of sexual abuse. 8 patients had a history of sexual abuse but no genital symptoms. 79% had genital symptoms of vaginal discharge. 39 patients aged under 5 years had a vaginal discharge, and 10 had a history of sexual abuse. 29 cases were determined not to be related to sexual abuse. There were 61 children infected with Neisseria gonorrhoea, 17 children with Gardnerella vaginalis, 14 children with Chlamydia trachomatis, 9 children with Trichomonas vaginalis, and 9 children with Treponema pallidum (positive cultures for syphilis, but without clinical features). Sexual child abuse was found to be higher than previously reported at this center. The approach in this study was to deny sexual abuse until confirmation of a sexually transmitted disease. Almost 33% of children in this study had no physical evidence of sexual abuse. The hospital policy is to teach children and caregivers safety skills and awareness and to develop a rapport with parents. Ceftriaxone was administered as therapy, since most children had gonorrhea, and there was resistance to penicillin and poor follow-up. The authors find that all children with Gardnerella vaginalis should be investigated for child sexual abuse. There was an express need for follow-up of patients due to the almost 10% with multiple infections.

PMID: 8556444 [PubMed - indexed for MEDLINE]

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