Objective:
To determine the clinical predictors of Neisseria gonorrhoeae infection in children examined for sexual abuse.
Design:
Retrospective review of a prospective management plan.
Setting:
A 240-bed children's hospital with 36000 emergency department visits per year.
Intervention:
In 1988, a Pediatric Emergency Medicine Department protocol was introduced for the examination of children who present with complaints suggestive of sexual abuse.
Results:
From January 1990 through December 1991, the records of all children less than 12 years of age examined for suspected sexual abuse were reviewed. Vaginal/urethral, oral, and rectal cultures for N gonorrhoeae were performed in 316 children. Seven children (2.2%) had a total of 12 positive cultures: seven vaginal/urethral, four rectal, and one oral. Evidence of vaginal/urethral discharge on physical examination was the best predictor of N gonorrhoeae infection (sensitivity, 100%; specificity, 88%; positive predictive value, 16%; and negative predictive value, 100%). Historical and physical evidence of discharge was significantly associated with N gonorrhoeae infection (P<.0006 and P<.000001, respectively).
Conclusions:
Children less than 12 years of age examined for sexual abuse who did not have evidence on physical examination of vaginal or urethral discharge were found to have a 100% probability of having negative vaginal/urethral, oral, and rectal N gonorrhoeae cultures. These findings do not support the practice of obtaining cultures for N gonorrhoeae routinely in all children who present for evaluation of possible sexual abuse.(Arch Pediatr Adolesc Med. 1995;149:86-89)