Are rectogenital chlamydial infections a marker of sexual abuse in children?

In order to examine the occurrence of chlamydial infection in sexually abused children, we cultured 51 abused children and 43 controls, 2 to 14.5 years of age. Only seven of the children were male. Chlamydia trachomatis was isolated from the vagina or rectum of two abused girls, 10 and 12 years of age, at their follow-up examination several weeks after the suspected abuse. C. trachomatis was also isolated from the vaginal culture of two controls and from the throat and rectum of another girl enrolled as a control. The two control children with vaginal infection were sisters, 7 and 10 years of age, who had been abused by their step-father 3 years previously. An antichlamydial immunoglobulin greater than or equal to 1:32 or a fourfold rise in the titer of immunoglobulin G was found in 13 of 49 (27%) abused children and 2 of 40 (5%) controls. This difference was statistically significant. The isolation of C. trachomatis from a rectogenital site was not limited to children with recent sexual abuse in this population. Serology may also be of limited use since serologic evidence of recent chlamydial infection was present in 5% of controls.