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ARTICLES:
Rebecca G. Girardet, Sheela Lahoti, Laurie A. Howard, Nancy N. Fajman, Mary K. Sawyer, Elizabeth M. Driebe, Francis Lee, Robert L. Sautter, Earl Greenwald, Consuelo M. Beck-Sagué, Margaret R. Hammerschlag, and Carolyn M. Black
Epidemiology of Sexually Transmitted Infections in Suspected Child Victims of Sexual Assault
Pediatrics 2009; 124: 79-86 [Abstract] [Full text] [PDF]
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[Read eLetters] Impact of Pubertal Status on Acquistion of STIs
Jan E. Paradise, M.D.   (28 October 2009)

Impact of Pubertal Status on Acquistion of STIs 28 October 2009
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Jan E. Paradise, M.D.,
Department of Pediatrics
Signature Medical Group, Brockton, MA

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Re: Impact of Pubertal Status on Acquistion of STIs

jeparadise{at}hotmail.com Jan E. Paradise, M.D.

To the editor:

In their impressive, multicenter study, Dr. Girardet and colleagues highlight their observation that "...10 girls with normal examinations also received a diagnosis of an STI, 1 of whom tested positive for gonorrhea...A positive test for gonorrhea in a child with normal examination findings was unanticipated.."

Although this report provides data concerning the age distribution of the children who were tested for sexually transmitted infections, it does not provide data concerning their pubertal status. Approximately one- third of the children were 11 to 13 years old. Presumably, that group included a number of post-pubertal girls and boys. It seems likely that some girls were post-menarchal. In girls, lower genital tract infections with gonorrhea and chlamydia are vaginal in location before puberty but localize to the cervix after puberty.(ref 1) Regarding infection caused by Trichomonas, clinical experience and some research reports suggest that, in the absence of estrogenized vaginal mucosa, girls do not acquire vaginitis even if they are exposed to the organism.

To allow fuller interpretation of this excellent study and to maximize its contribution to clinical decision-making, the incidence of STIs in the study subjects should be analyzed according to their pubertal status. In particular, this analysis is needed for gonococcal, chlamydial, and trichomonal infections in girls, since the manifestations of these infections are clearly influenced by girls' pubertal status.

1. Gutman L, "Gonococcal diseases in infants and children." In Holmes KK, et al, eds. Sexually Transmitted Diseases, 3rd Edition. NY: McGraw-Hill, 1999, p. 1149.

Conflict of Interest:

None declared