Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 79-86 (doi:10.1542/peds.2008-2947)
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ARTICLE

Epidemiology of Sexually Transmitted Infections in Suspected Child Victims of Sexual Assault

Rebecca G. Girardet, MDa, Sheela Lahoti, MDa, Laurie A. Howard, MSb, Nancy N. Fajman, MDc, Mary K. Sawyer, MDc, Elizabeth M. Driebe, MSb, Francis Lee, PhDc, Robert L. Sautter, PhDd, Earl Greenwald, MDd, Consuelo M. Beck-Sagué, MDb, Margaret R. Hammerschlag, MDe and Carolyn M. Black, PhDb

a Department of Pediatrics, University of Texas-Houston Medical School, Houston, Texas
b Department of Pediatrics, Centers for Disease Control and Prevention, Atlanta, Georgia
c Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
d Department of Pediatrics, Children's Resource Center at Pinnacle Health, Harrisburg, Pennsylvania
e Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, New York

OBJECTIVE: The objective of this study was to describe the epidemiology of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, HIV, and herpes simplex virus type 2 (HSV-2) infection diagnosed by culture or by serologic or microscopic tests and by nucleic acid amplification tests in children who are evaluated for sexual victimization.

METHODS: Children aged 0 to 13 years, evaluated for sexual victimization, who required sexually transmissible infection (STI) testing were enrolled at 4 US tertiary referral centers. Specimens for N gonorrhoeae and C trachomatis cultures, wet mounts for detection of T vaginalis, and serologic tests for syphilis and HIV were collected and processed according to study sites' protocols. Nucleic acid amplification tests for C trachomatis and N gonorrhoeae and serologic tests for HSV-2 were performed blinded to other data.

RESULTS: Of 536 children enrolled, 485 were female. C trachomatis was detected in 15 (3.1%) and N gonorrhoeae in 16 (3.3%) girls. T vaginalis was identified in 5 (5.9%) of 85 girls by wet mount, 1 (0.3%) of 384 children had a positive serologic screen for syphilis, and 0 of 384 had serologic evidence of HIV infection. Of 12 girls who had a specimen for HSV-2 culture, 5 (41.7%) had a positive result; 7 (2.5%) of 283 had antibody evidence of HSV-2 infection. Overall, 40 (8.2%) of 485 girls and 0 of 51 boys (P = .02) had ≥1 STI. Girls with vaginal discharge were more likely to test positive for an STI (13 [24.5%] of 53) than other girls (27 [6.3%] of 432; prevalence ratio = 3.9; P < .001), although 10 girls with STIs had normal physical examinations. Most girls (27 [67.5%]) with a confirmed STI had normal or nonspecific findings on anogenital examination.

CONCLUSIONS: The prevalence of each STI among sexually victimized children is <10%, even when highly sensitive detection methods are used. Most children with STIs have normal or nonspecific findings on physical examination.

Key Words: sexually transmitted infection • sexual abuse • epidemiology • child

Abbreviations: STI—sexually transmissible infection • CDC—Centers for Disease Control and Prevention • NAAT—nucleic acid amplification test • HSV-2—herpes simplex virus type 2

Accepted Feb 9, 2009.


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