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

Kellogg, Nancy D.; Melville, Joel G̀.; Lukefahr, James L.; Nienow, Shalon M.; Russell, Edward Lee

doi:10.1097/pec.0000000000001014

Cited by 25 publications

(14 citation statements)

References 21 publications

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“…6 A few previous studies of adolescents and adults have reported gonorrhea and chlamydia infections isolated from extragenital sites using NAAT testing. 8,9 In a recent study 10 of 1319 children and adolescents who presented for acute and nonacute assessments for sexual abuse/assault and were tested for gonorrhea and chlamydia, 120 had at least 1 positive NAAT from a genital or extragenital (oral, anal) site. Most patients who tested positive for gonorrhea or chlamydia did not have genital discharge and most who had positive results from extragenital sites did not provide a history of contact at that site.…”

Section: Testing For Sexually Transmitted Infectionsmentioning

confidence: 99%

Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018

Adams

Farst

Kellogg

2018

Journal of Pediatric and Adolescent Gynecology

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129

111

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Most sexually abused children will not have signs of genital or anal injury, especially when examined nonacutely. A recent study reported that only 2.2% (26 of 1160) of sexually abused girls examined nonacutely had diagnostic physical findings, whereas among those examined acutely, the prevalence of injuries was 21.4% (73 of 340). It is important for health care professionals who examine children who might have been sexually abused to be able to recognize and interpret any physical signs or laboratory results that might be found. In this review we summarize new data and recommendations concerning documentation of medical examinations, testing for sexually transmitted infections, interpretation of lesions caused by human papillomavirus and herpes simplex virus in children, and interpretation of physical examination findings. Updates to a table listing an approach to the interpretation of medical findings is presented, and reasons for changes are discussed.

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Section: Testing For Sexually Transmitted Infectionsmentioning

confidence: 99%

Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018

Adams

Farst

Kellogg

2018

Journal of Pediatric and Adolescent Gynecology

Self Cite

129

111

View full text Add to dashboard Cite

show abstract

“…This is important since the individual could serve as a reservoir for ongoing transmission cycles, especially with increasing reports of oral-genital sexual practice among adolescents (23,24). A recent study in children evaluated for sexual victimization showed that C. trachomatis and N. gonorrhoeae can be detected in anatomic sources where no prior sexual contact was reported (12). A comprehensive screening practice for C. trachomatis and N. gonorrhoeae with a history or suspicion of recent sexual contact could aid in diagnosis of STI.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, data from an evidencebased systematic review showed that in children younger than 12 years of age, most of the cases of C. trachomatis (75 to 94%) and N. gonorrhoeae (36 to 85%) infections were linked to sexual assault (25). A recent study in children and adolescents being evaluated for sexual abuse shows that C. trachomatis infection and gonorrhea were detected in extragenital sites (oropharynx and rectum), even when sexual contact with the abuser's genitals was not reported (12). A recent study showed that appropriate STI testing, including for C. trachomatis and N. gonorrhoeae in extragenital sites was done only for 5% of adolescents presenting to the emergency department with oropharyngeal or anorectal chief complaints (26).…”

Section: Discussionmentioning

confidence: 99%

“…Data on the relative yield of sampling the oropharynx, rectum, and urine for C. trachomatis and N. gonorrhoeae laboratory testing are sparse in pediatric populations, mainly due to limited testing of these sources and probably also due to relatively low suspicion of extragenital infection in this patient population (10,11). A recent study in sexually abused children showed that C. trachomatis and N. gonorrhoeae infections were detected at extragenital sites in the absence of a history of extragenital sexual contact, highlighting the importance of comprehensive screening practices, especially in children being evaluated for sexual assault (12). A limitation of that study is that it only included patients that potentially had a high-risk exposure and did not determine discordances in C. trachomatis and N. gonorrhoeae positivity by anatomic site.…”

mentioning

confidence: 99%

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Extragenital Screening Is Essential for Comprehensive Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in the Pediatric Population

Uprety

Cárdenas

2019

J Clin Microbiol

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Chlamydia trachomatis and Neisseria gonorrhoeae are the two most common causes of sexually transmitted disease in the United States. Studies in adults, mostly in men who have sex with men, have shown that the prevalence of C. trachomatis and N. gonorrhoeae infections is much higher in extragenital sources compared to urogenital sources. A similar large sample of data on the burden of C. trachomatis and N. gonorrhoeae infections by anatomic site is lacking in children. We retrospectively analyzed data from 655 patients tested for C. trachomatis (887 specimens) and N. gonorrhoeae (890 specimens) at the Children’s Hospital of Philadelphia. We restricted the analysis to include patients between 2 and 17 years of age that had all three sources (urine, oropharynx, and rectum) collected at the same visit. The final data set included specimens from all three sources from 148 and 154 patients for C. trachomatis and N. gonorrhoeae, respectively. Specimens were tested for C. trachomatis and N. gonorrhoeae using a Gen-Probe Aptima Combo 2 assay. The burden of C. trachomatis and N. gonorrhoeae infection was significantly higher in the 14- to 17-year age group (24.7%, P = 0.041; 25.8%; P = 0.001) compared to the 10- to 13-year (5.9%; 5.6%), 6- to 9-year (4.6%; 4.6%), and 2- to 5-year (8.3%; 0%) age groups, respectively. The positivity rate for C. trachomatis was highest for rectal (16.2%), followed by urine (5.4%) and oropharyngeal (0.7%) sites. The positivity rate for N. gonorrhoeae was highest for rectal sites (10.4%), followed by oropharyngeal (9.7%) and urine (1.9%) sites. The source with highest diagnostic yield is rectum for C. trachomatis and rectum and oropharynx for N. gonorrhoeae. Hence, extragenital screening is critical for the comprehensive detection of C. trachomatis and N. gonorrhoeae in the pediatric population.

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“…American Academy of Pediatrics, yüksek sensitivetisi ve kültüre yakın spesifitesi nedeniyle bu etkenlerin saptanmasında NAAT'ni önermektedir. Ayrıca son yıllarda yapılmış çalışmalarda, cinsel istismar sonrası ekstragenital örneklerde de NAAT'nin kullanılabileceği bildirilmektedir (47,48).…”

Section: B3 Etken Taraması Ve Tanı Testleriunclassified

Cinsel Saldırı ve İstismar Olgularında Cinsel Yolla Bulaşan Hastalıkların Değerlendirilmesi

Çağlayan¹,

Kaya²,

Aktaş³

2020

Bull Leg Med

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Cinsel saldırı ve cinsel istismar olgularının fiziksel ve ruhsal travma ile birlikte cinsel yolla bulaşan hastalıklar (CYBH) açısından da değerlendirilmesi önemlidir. Bu olgularda muayene genellikle travma bulgularının tespiti ve saldırganın kimliğinin tespitine yönelik örnek alımı ile sınırlı olmaktadır. Cinsel yolla bulaşan Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Hepatit B virüsü, Human immunodeficiency virüs ve sifiliz gibi çok sayıda etken mevcut olmakla birlikte ülkemizde bu etkenlere yönelik tarama testleri ve profilaksi uygulamaları ile ilgili standardize edilmiş bir rehber bulunmamaktadır. Bu nedenle, tüm olgularda bulaş riski göz önünde bulundurulmalı, gereklilik halinde tedavi ve profilaksi uygulamaları açısından değerlendirme yapılmalıdır. Ayrıca saldırgana ulaşılabildiği durumlarda gerek mağdurun CYBH için tıbbi bakım ihtiyacının belirlenebilmesi gerekse saldırganın yargılanma süreci ve illiyet bağının kurulabilmesi için bu kişilerin de muayenesi ve tetkikleri yapılmalıdır. Bu derlemede, cinsel saldırı ve cinsel istismar mağdurlarında görülebilecek cinsel yolla bulaşan hastalıkların değerlendirilmesi ve saldırganın muayenesi hususlarının, literatür bilgileri eşliğinde, adli-tıbbi yönden incelenerek sağlık çalışanlarının bu konuya dikkatlerini çekmek amaçlandı.

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

Cited by 25 publications

References 21 publications

Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018

Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018

Extragenital Screening Is Essential for Comprehensive Detection of Chlamydia trachomatis and Neisseria gonorrhoeae in the Pediatric Population

Cinsel Saldırı ve İstismar Olgularında Cinsel Yolla Bulaşan Hastalıkların Değerlendirilmesi

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