The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: rationale for limited STD testing in prepubertal girls

Physicians may perform fewer screening tests for sexually transmitted diseases (STDs) in children being evaluated for sexual abuse than recommended by the American Academy of Pediatrics (AAP) guidelines, if they take into consideration certain clinical observations. Reducing the number of tests would save money. During 1992, 855 children of both sexes under age 18 were evaluated for sexual abuse in a Cincinnati hospital. Of those, 542 met AAP criteria for testing, of whom 458 had at least one test for gonorrhea, chlamydia, trichomonas, or syphilis, and 140 children had HIV screening. A group of 156 children not meeting AAP guidelines also had testing; none had an STD. Overall, 26 children had STDs. Based on associations found in this study, unless history indicates high-risk status, prepubertal girls need not be tested for trichomonas or gonorrhea unless they have a vaginal discharge. Adding this criterion would have saved $22,000 among the 855 cases studied. All pubertal girls should have a full series of STD tests. Results may not apply to other populations.
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&apos;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, Ngonorrhoeae 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&apos;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 Ngonorrhoeae, 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. Pediatrics 1995,96:1090-1094; sexual abuse, gonorrhea, chlamydia, HIV, syphilis, trichomonas.
ABBREVIATIONS. STD, sexually transmitted disease; HIV, human immunodeficiency virus; AAP, American Academy of Pediatrics; CHMC, Chddren's Hospital Medical Center; ED, emergency department; ELISA, enzyme-linked immunosorbent assay. Children and adolescents who [...]