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Multicenter Study of Nucleic Acid Amplification Tests for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in Children Being Evaluated for Sexual Abuse

Black, Carolyn M. PhD*; Driebe, Elizabeth M. MS*; Howard, Laurie A. MS*; Fajman, Nancy N. MD; Sawyer, Mary K. MD; Girardet, Rebecca G. MD; Sautter, Robert L. PhD§; Greenwald, Earl MD§; Beck-Sague, Consuelo M. MD*; Unger, Elizabeth R. MD, PhD*; Igietseme, Joseph U. PhD*; Hammerschlag, Margaret R. MD

The Pediatric Infectious Disease Journal: July 2009 - Volume 28 - Issue 7 - p 608-613
doi: 10.1097/INF.0b013e31819b592e
Original Studies

Background: Diagnosis of sexually transmitted infections in children suspected of sexual abuse is challenging due to the medico-legal implications of test results. Currently, the forensic standard for diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections is culture. In adults, nucleic acid amplification tests (NAATs) are superior to culture for CT, but these tests have been insufficiently evaluated in pediatric populations for forensic purposes.

Methods: We evaluated the use of NAATs, using urine and genital swabs versus culture for diagnosis of CT and NG in children evaluated for sexual abuse in 4 US cities. Urine and a genital swab were collected for CT and NG NAATs along with routine cultures. NAAT positives were confirmed by PCR, using an alternate target.

Results: Prevalence of infection among 485 female children were 2.7% for CT and 3.3% for NG by NAAT. The sensitivity of urine NAATs for CT and NG relative to vaginal culture was 100%. Eight participants with CT-positive and 4 with NG-positive NAATs had negative culture results (P = 0.018 for CT urine NAATs vs. culture). There were 24 of 485 (4.9%) female participants with a positive NAAT for CT or NG or both versus 16 of 485 (3.3%) with a positive culture for either, resulting in a 33% increase in children with a positive diagnosis.

Conclusions: These results suggest that NAATs on urine, with confirmation, are adequate for use as a new forensic standard for diagnosis of CT and NG in children suspected of sexual abuse. Urine NAATs offer a clear advantage over culture in sensitivity and are less invasive than swabs, reducing patient trauma and discomfort.


From the *Centers for Disease Control and Prevention, Atlanta, GA; †Emory University School of Medicine, Atlanta, GA; ‡Department of Pediatrics, The University of Texas-Houston Medical School, Houston, TX; §Department of Pediatrics, Children's Resource Center at Pinnacle Health, Harrisburg, PA; and ¶SUNY Downstate Medical Center, Brooklyn, NY.

Accepted for publication January 7, 2009.

Funding for this project was provided by the Centers for Disease Control and Prevention Office of Women's Health, Cooperative Agreement Nos. US6/CCU417921-01, US6CCU617918-01, US6/CCU217922-01; and by the National Center for Infectious Diseases Office of Minority and Women's Health.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the funding agency. Brand names are used for informational purposes only and should not be considered as endorsements by the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Address for correspondence: Carolyn M. Black, PhD, Mailstop C17, Centers for Disease Control and Prevention, Atlanta, GA 30333. E-mail:

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© 2009 Lippincott Williams & Wilkins, Inc.