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The Prevalence of Sexually Transmitted Diseases in Children and Adolescents Evaluated for Sexual Abuse in Cincinnati: Rationale for Limited STD Testing in Prepubertal Girls

Robert M. Siegel MD1, Charles J. Schubert MD2, Patricia A. Myers MSW3, , Robert A. Shapiro MD2


1 Division of General Pediatrics, Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, The Northern Kentucky Children's Advocacy Center, St. Luke Hospital, Bellevue, KY
2 Division of Emergency Medicine, Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
3 Division of Social Services, Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH


Objective. To determine the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, syphilis, and human immunodeficiency virus (HIV) infection in sexually abused children and to develop selective criteria for sexually transmitted disease (STD) testing in these children in our community.

Design. Prospective.

Setting. University-affiliated children's hospital in Ohio.

Participants. All children evaluated at our hospital for sexual abuse were eligible. Eight hundred fifty-five children were evaluated over a 1-year period. The study included 704 girls and 151 boys. Children ranged in age from 3 weeks to 18 years old.

Methods and Results. Standard STD testing (American Academy of Pediatrics recommendations) was defined as serum rapid plasma reagin test, examination for Trichomonas, N gonorrhoeae culture of the throat, rectum, and genitalia and C trachomatis culture of the rectum and genitalia. STD testing in this study was recommended in children with 1) a history of genital discharge or contact with the perpetrator's genitalia, 2) examination findings of genital discharge or trauma, and 3) all adolescents. HIV testing was obtained in children with risk factors for HIV infection, those with contact with a perpetrator with HIV risk factors, or if the family was concerned about HIV acquisition. A total of 423 children were tested for N gonorrhoeae, 415 for C trachomatis, 275 for syphilis, 208 for Trichomonas, and 140 for HIV. Twelve children were determined to have N gonorrhoeae infection, 11 had C trachomatis infection, and four had Trichomonas infection. Overall, the prevalence of STDs in prepubertal girls was 3.2% and 14.6% in pubertal girls. The prevalence of N gonorrhoeae in prepubertal girls with vaginal discharge was 11.1% and 0% in prepubertal girls without discharge (P .001). C trachomatis infection was diagnosed in 0.8% of prepubertal girls compared with 7.0% of pubertal girls (P .001). None of the children tested positive for syphilis or HIV and no males had a STD.

Conclusions. In our community, N gonorrhoeae testing in prepubertal girls can be limited to those with a vaginal discharge on examination unless other risk factors are present. The prevalence C trachomatis and Trichomonas in prepubertal girls is low and may be omitted from routine evaluations. All pubertal girls evaluated for sexual abuse should be tested for STDs because of the high prevalence of asymptomatic infection in this patient population.

Submitted on June 6, 1994
Accepted on January 19, 1995

Findings From STD Screening of Adolescents and Adults Entering Corrections Facilities: Implications for STD Control Strategies




Background: Persons entering corrections facilities are at high risk for sexually transmitted diseases (STDs) because of risky sexual behavior and lack of access to routine screening.

Goal: The goal of the study was to develop a national picture of STD prevalence in this population.

Study Design: We analyzed information on age, race/ethnicity, urethral symptoms (men only), and test results for approximately 85,000 chlamydia, 157,000 gonorrhea, and 293,000 syphilis tests for persons entering 23 jails and 12 juvenile detention centers in 13 US counties from 1996 through 1999.

Results: At adult jails in nine counties, the median percentage of persons with reactive syphilis tests by county was 8.2% (range, 0.3-23.8%) for women and 2.5% (range, 1.0-7.8%) for men. At juvenile detention facilities in five counties, the median positivity for chlamydial infection was 15.6% (range, 8.0-19.5%) for adolescent girls and 7.6% (range, 2.8-8.9%) for adolescent boys; the median positivity for gonorrhea was 5.2% (range, 3.4-10.0%) for adolescent girls and 0.9% (range, 0.7-2.6%) for adolescent boys. Of adolescent boys testing positive for chlamydial infection at three juvenile facilities, approximately 97% did not report symptoms; of adolescent boys positive for gonorrhea, 93% did not report symptoms.

Conclusion: STD positivity among persons entering corrections facilities is high. Most chlamydial and gonococcal infections are asymptomatic and would not be detected without routine screening. Monitoring the prevalence of STDs in this population is useful for planning STD prevention activities in corrections facilities and elsewhere in the community.

Community-Based Screening and Treatment for STDs: Results from a Mobile Clinic Initiative

Kahn, Richard H. MS*; Moseley, Kera E. DrPH, MPH†; Thilges, John N. BA∥; Johnson, Gwendolyn BS‡; Farley, Thomas A. MD, MPH§



Background: The persistence of syphilis and other bacterial sexually transmitted diseases (STDs) in many areas of the United States suggests that innovative approaches to controlling these diseases are needed.

Goal: To evaluate the feasibility, acceptability, and yield of mobile community-based STD screening and treatment services in high STD incidence areas.

Study Design: Free, voluntary, confidential screening and treatment for STDs were conducted in high STD incidence neighborhoods of Baton Rouge, Louisiana, using a 32-foot mobile van. Demographic and behavioral data were obtained from participants. Participants were screened for syphilis, chlamydia, and gonorrhea and were also offered HIV testing. Community attitudes toward the screening program were assessed with street-intercept surveys conducted two weeks after screening events.

Results: From March 1997 to August 2000, 256 community-based screening events were held. During this period, 3110 blood samples were collected for syphilis testing, of which 37 (1.2%) new cases of syphilis were identified. Of the 2807 blood samples collected for HIV testing, 70 (2.5%) were positive. Of 2229 urine samples, 185 (8.3%) tested positive for Chlamydia trachomatis and 108 (4.9%) positive for Neisseria gonorrhoeae. Of 389 street-intercept surveys, 97% of respondents thought that neighborhood STD testing was a good or very good idea.

Conclusion: Mobile community-based STD screening and treatment are feasible, identify high positivity of STDs, and are accepted by the community as an innovative approach to STD control.


Association of Adolescents' History of Sexually Transmitted Disease (STD) and Their Current High-Risk Behavior and STD Status: A Case for Intensifying Clinic-Based Prevention Efforts





Background: Adolescents are at high risk of sexually transmitted disease (STD)/HIV infection, and one vulnerable subgroup is African American females. The association between adolescents' previous experience of STD and recent sexual risk behaviors has been ill-defined.

Goal: The goal was to examine the associations between adolescents' self-reported history of STD diagnosis and current sexual risk behaviors, prevention knowledge and attitudes, and STD infection status.

Study Design: This was a cross-sectional survey. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and STDs. Participants were sexually active adolescent females (N = 522) 14 to 18 years of age. Information on STD history and current sexual behaviors (within the 30 days before assessment) was collected in face-to-face interviews. Less sensitive topics, such as STD prevention knowledge, attitudes about condom use, and perceived barriers to condom use, were addressed via self-administered survey. DNA amplification of vaginal swab specimens provided by the adolescents was performed to determine current STD status. Outcomes associated with past STD diagnosis were determined by means of logistic regression to calculate adjusted odds ratios (AORs) in the presence of observed covariates.

Results: Twenty-six percent of adolescents reported ever having an STD diagnosed. Although past STD diagnosis was associated with increased STD prevention knowledge, it was not associated with increased motivation to use condoms. Compared with adolescents who had never had an STD, adolescents with a history of diagnosed STD were more likely to report not using a condom at most recent intercourse (AOR = 2.54; 95% CI = 1.64-3.93;P = 0.0001), recent unprotected vaginal intercourse (AOR = 1.79; 95% CI = 1.15-2.79;P = 0.010), inconsistent condom use (AOR = 2.27; 95% CI = 1.46-3.51;P < .0001), sexual intercourse while drinking alcohol (AOR = 2.09; 95% CI = 1.33-3.28;P = 0.001), and unprotected intercourse with multiple partners (AOR = 3.29; 95% CI = 1.09-9.89;P = 0.034). Past STD diagnosis was associated with increased risk for current biologically confirmed gonorrhea and trichomoniasis (AOR = 2.48; 95% CI = 1.09-5.23;P = 0.030; and AOR = 2.05; 95% CI = 1.18-3.59;P = 0.011, respectively). Past STD diagnosis was not significantly associated with increased risk of current biologically confirmed chlamydia (AOR = 0.78; 95% CI = 0.45-1.37;P = 0.38).

Conclusion: Among this sample of female adolescents, past STD diagnosis was an indicator of current high-risk sexual activity and increased risk for two common STDs: gonorrhea and trichomoniasis. Although adolescents may gain factual knowledge from the experience of having an STD diagnosed, they are not applying that knowledge to their current sexual behaviors. Thus, these adolescents remain at risk for subsequent STD infection. Therefore, the findings suggest that there is a need to intensify clinic-based prevention efforts directed toward adolescents with a history of STDs, as a strategy for reducing STD-associated risk behaviors and, consequently, the likelihood of new STD infections.