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1996-02-27
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Document 0633
DOCN M9630633
TI The prevalence of sexually transmitted diseases in children and
adolescents evaluated for sexual abuse in Cincinnati: rationale for
limited STD testing in prepubertal girls.
DT 9603
AU Siegel RM; Schubert CJ; Myers PA; Shapiro RA; Division of General
Pediatrics, Children's Hospital Medical; Center, Cincinnati, OH, USA.
SO Pediatrics. 1995 Dec;96(6):1090-4. Unique Identifier : AIDSLINE
MED/96095159
AB OBJECTIVE. To determine the prevalence of Chlamydia trachomatis,
Neisseria gonorrhoeae, Trichomonas vaginalis, syphilis, and human
immunodeficiency virus (HIV) infection in sexually abused children and
to develop selective criteria for sexually transmitted disease (STD)
testing in these children in our community. DESIGN. Prospective.
SETTING. University-affiliated children's hospital in Ohio.
PARTICIPANTS. All children evaluated at our hospital for sexual abuse
were eligible. Eight hundred fifty-five children were evaluated over a
1-year period. The study included 704 girls and 151 boys. Children
ranged in age from 3 weeks to 18 years old. METHODS AND RESULTS.
Standard STD testing (American Academy of Pediatrics recommendations)
was defined as serum rapid plasma reagin test, examination for
Trichomonas, N gonorrhoeae culture of the throat, rectum, and genitalia
and C trachomatis culture of the rectum and genitalia. STD testing in
this study was recommended in children with 1) a history of genital
discharge or contact with the perpetrator's genitalia, 2) examination
findings of genital discharge or trauma, and 3) all adolescents. HIV
testing was obtained in children with risk factors for HIV infection,
those with contact with a perpetrator with HIV risk factors, or if the
family was concerned about HIV acquisition. A total of 423 children were
tested for N gonorrhoeae, 415 for C trachomatis, 275 for syphilis, 208
for Trichomonas, and 140 for HIV. Twelve children were determined to
have N gonorrhoeae infection, 11 had C trachomatis infection, and four
had Trichomonas infection. Overall, the prevalence of STDs in
prepubertal girls was 3.2% and 14.6% in pubertal girls. The prevalence
of N gonorrhoeae in prepubertal girls with vaginal discharge was 11.1%
and 0% in prepubertal girls without discharge (P < .001). C trachomatis
infection was diagnosed in 0.8% of prepubertal girls compared with 7.0%
of pubertal girls (P < .001). None of the children tested positive for
syphilis or HIV and no males had a STD. CONCLUSIONS. In our community, N
gonorrhoeae testing in prepubertal girls can be limited to those with a
vaginal discharge on examination unless other risk factors are present.
The prevalence C trachomatis and Trichomonas in prepubertal girls is low
and may be omitted from routine evaluations. All pubertal girls
evaluated for sexual abuse should be tested for STDs because of the high
prevalence of asymptomatic infection in this patient population.
DE Adolescence Chi-Square Distribution Child Child Abuse,
Sexual/DIAGNOSIS/*STATISTICS & NUMER DATA Child, Preschool Comparative
Study Female Human HIV Infections/DIAGNOSIS/EPIDEMIOLOGY HIV-1
Infant Infant, Newborn Male Ohio/EPIDEMIOLOGY Prevalence
Prospective Studies Sexually Transmitted Diseases,
Bacterial/DIAGNOSIS/*EPIDEMIOLOGY Sexually Transmitted Diseases,
Viral/DIAGNOSIS/*EPIDEMIOLOGY Urban Population/*STATISTICS & NUMER DATA
JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).