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Genital and Extragenital Gonorrhea and Chlamydia in Children and Adolescents Evaluated for Sexual Abuse

Kellogg, Nancy D., MD, FAAP*†; Melville, John D., MS, MD, FAAP; Lukefahr, James L., MD, FAAP*†; Nienow, Shalon M., MD, FAAP§; Russell, Edward L., PhD, RN, ACNS-BC, AFN-BC, SANE-A, SANE-P, CA-CPSANE, CFN, DABFN

doi: 10.1097/PEC.0000000000001014
Original Articles

Objective The aim of this study was to describe the use of a nucleic acid amplification test in detecting genital and extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in children and adolescents assessed for sexual abuse/assault.

Methods The charts of children aged 0 to 17 years, consecutively evaluated for sexual victimization, in emergency department and outpatient settings were reviewed. Data extracted included age, sex, type of sexual contact, anogenital findings, previous sexual contact, toxicology results, and sites tested for NG and CT.

Results Of the 1319 patients who were tested, 579 were tested at more than 1 site, and 120 had at least 1 infected site. Chlamydia trachomatis was identified in 104 patients, and NG was found in 33. In bivariate analysis, a positive test was associated with female sex, age older than 11 years, previous sexual contact, acute or healed genital injury, drug/alcohol intoxication, and examination within 72 hours of sexual contact. Fifty-one patients had positive anal tests, and 24 had positive oral tests. More than 75% of patients with positive extragenital tests had additional positive tests or anogenital injury. Most with a positive anal (59%) or oral (77%) test did not report that the assailant's genitals came into contact with that site.

Conclusions Positive tests for NG and CT in patients evaluated for sexual victimization may represent infection from sexual contact, contiguous spread of infection, or the presence of infected assailant secretions. Relying on patient reports of symptoms, or types of sexual contact, to determine need for testing may miss NG and CT infections in patients evaluated for sexual victimization.

From the *University of Texas Health Science Center at San Antonio; and

Children's Hospital of San Antonio Center for Miracles, San Antonio, TX;

Division of Child Abuse Pediatrics, Medical University of South Carolina, Charleston, SC;

§University of New Mexico, Albuquerque, NM; and

Children's Hospital of San Antonio, San Antonio, TX.

Disclosure: The authors declare no conflict of interest.

Reprints: Nancy D. Kellogg, MD, FAAP, Division of Child Abuse, Department of Pediatrics, University of Texas Health Science Center at San Antonio, Mail Code 7821, 7703 Floyd Curl Dr, San Antonio, TX 8229-3900 (e-mail: kelloggn@uthscsa.edu).

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