Shapiro R A, Schubert C J, Myers P A
Division of Emergency Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229.
Pediatr Emerg Care. 1993 Dec;9(6):341-5. doi: 10.1097/00006565-199312000-00004.
Cultures for sexually transmitted diseases (STDs) are frequently obtained as part of an evaluation for alleged sexual abuse, but the prevalence of STDs in abused children is very low. Furthermore, STDs in children may not be identified if the clinician does not maintain a high index of suspicion in the symptomatic child. A retrospective review was done to study the symptoms and presenting complaints of girls under 12 with gonorrhea and chlamydia infections and to examine the prevalence of STDs in asymptomatic girls. The charts of 622 patients were reviewed. All patients were females under 12, Tanner I or II, who were initially seen for evaluation of sexual abuse or who were diagnosed with an STD. During the study period, 28 girls were found to have STDs. Twenty-two of these girls had vaginal gonorrhea; vaginal chlamydia was diagnosed in eight. Twenty-three of the 28 girls (82%) with an STD were initially seen and cultured for a chief complaint of vaginal discharge. Of the 581 patients who were cultured for evaluation of abuse, only five STDs were diagnosed (0.7%). All 22 girls with gonorrhea had a vaginal discharge on examination. Of the eight girls with chlamydia, two also had vaginal gonorrhea. Of the six who had chlamydia without gonorrhea, asymptomatic infection was common; four gave histories of discharge but only one had a discharge on examination. Our review indicates that girls under 12 who present for evaluation of vaginal discharge may have an STD and should be cultured for gonorrhea and chlamydia whether or not sexual abuse is suspected.(ABSTRACT TRUNCATED AT 250 WORDS)
作为对疑似性虐待评估的一部分，常进行性传播疾病（STD）培养，但受虐儿童中STD的患病率非常低。此外，如果临床医生对有症状的儿童未保持高度怀疑指数，儿童中的STD可能无法被识别。进行了一项回顾性研究，以探讨12岁以下患淋病和衣原体感染女孩的症状及就诊主诉，并检查无症状女孩中STD的患病率。回顾了622例患者的病历。所有患者均为12岁以下、坦纳I或II期的女性，她们最初因性虐待评估就诊或被诊断患有STD。在研究期间，发现28名女孩患有STD。其中22名女孩患有阴道淋病；8名被诊断为阴道衣原体感染。28名患有STD的女孩中有23名（82%）最初因阴道分泌物的主诉就诊并进行培养。在581例因性虐待评估而进行培养的患者中，仅诊断出5例STD（0.7%）。所有22例淋病女孩检查时均有阴道分泌物。8例衣原体感染女孩中，2例也患有阴道淋病。6例仅有衣原体感染而无淋病的女孩中，无症状感染很常见；4例有分泌物病史，但检查时只有1例有分泌物。我们的回顾表明，12岁以下因阴道分泌物就诊的女孩可能患有STD，无论是否怀疑有性虐待，均应进行淋病和衣原体培养。（摘要截短于250字）
