SEXUALLY-TRANSMITTED DISEASES IN CHILDREN AND EVIDENCE OF SEXUAL ABUSE

During the period June 1989 to March 1991, laboratory evidence of sexu ally transmitted diseases (STDs) was found in 107 patients at the Red Cross War Memorial Children's Hospital in Cape Town. Data was availabl e on 96 patients aged 23 months to 14 years (mean 75.9 months). Vagina l discharge was the most frequent presenting symptom (76%), particular ly in those less than 5 years of age (90%). Although a history of abus e was not given on presentation in 62%, evidence of abuse was subseque ntly elicited in 67% of patients. Neisseria gonorrhoeae was the most c ommon sexual pathogen (61 isolates, 8 penicillin resistant), followed by G vaginalis (17 isolates), Trichomonas vaginalis (7 infections), an d T pallidum (9 TPHA positive, 5 with VDRL 1:4 or higher). Chlamydia t rachomatis was demonstrated by immunofluorescence in 14 children. Mult iple STDs were demonstrated in 10 patients. Although evidence of CSA w as not found in all patients with STDs it was likely that the vast maj ority of patients had acquired these infections by CSA. Symptomatic pr epubertal children with G vaginalis isolates should be investigated fo r CSA. Chlamydial immunofluorescence tests did not assist the diagnosi s of CSA in children and should not be used, as they have no medicoleg al significance.