Inappropriate use of nonculture tests for the detection of Chlamydia trachomatis in suspected victims of child sexual abuse: A continuing problem

The introduction of nonculture tests for detection of Chlamydia trachomatis has revolutionized the management of chlamydial infections in sexually act ive adolescents and adults. However, these tests are insufficiently specifi c for use in genital and rectal sites in children; false-positive tests can be frequent. We report here 4 cases involving inappropriate use of noncult ure tests in children in New York City during 1998. Two cases involved the use of enzyme immunoassays with vaginal specimens. In both cases the initia l results were positive, however, cultures for C trachomatis performed late r were negative. In the third case, the DNA probe test for C trachomatis wa s used. The fourth child was being evaluated for sexually transmitted disea ses after rape. Although the pediatrician sent a rectal culture to a large commercial laboratory it was later determined that the laboratory was using an enzyme immunoassay for culture confirmation leading to a false-positive result. At the least the use of these inappropriate tests resulted in unne cessary retesting and at the worst, unnecessary hospitalization, erroneous reports of sexual abuse and possibly unjustified prosecution and incarcerat ion. Because of the social and legal implications it is important that prac titioners be aware of these recommendations and require that commercial lab oratories adhere to approved C trachomatis culture methods.