STDs in Children

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STDs in Children

• Robert Allan Shapiro, M.D.
• Childrens Hospital Medical Center
• Cincinnati, Ohio
• 513-636-7966

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Neisseria gonorrhoeae

• 1 million new infections / year in U.S.
• Almost certainly sexually transmitted in child
• Culture is the gold standard
• Culture technique
• use rayon or dacron tipped swabs
• plate on appropriate media immediately
• or transport within 12 hr. in swab-tube transport
  system

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Culture methods to ID GC in children lt 12 y/o

• Plate specimen on selective medium
• Martin-Lewis or other
• Make ID of Neisseria species
• gram - diplococci w/adjacent sides flattened
• oxidase positive
• Perform 2 confirmatory tests (for N. gonorrhoeae)
• DNA probe or PCR/LCR
• combined enzyme or modified conventional tests

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LCR tests for GC

• Opa gene (up to 11 copies/organism)
• Unique 48 base pair region is used
• Amplification is logarithmic
• 1 target ? 30-40 amplifications ? 1
  billion targets

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Treatment of GC

• Uncomplicated infection
• Ceftriaxone 125mg IM x 1
• Cefixime 400mg PO x 1
• Complicated infections require other treatment

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Herpes Simplex Virus

• Rectal or genital infection may indicate sexual
  abuse
• Type 2 more likely to be transmitted sexually
• Culture is the preferred method of ID
• Tests for other STDs may be indicated

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HSV Sexual Abuse
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Specimen collection for Herpes Simplex Virus

• Vesicles have large amounts of virus
• aspirate w/ fine gauge needle TB syringe
• or unroof the vesicle and scrape base
• Ulcers or pustules can also be cultured
• clean first with sterile saline
• swab base vigorously
• Dacron swabs are best
• calcium alginate swabs inhibit HSV growth

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HSV Culture

• Most sensitive test available
• Results usually within 3-7 days
• Staining with monoclonal antibodies
• increases specificity
• allows for typing of type 1 or type 2
• significance??

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HSV Direct detection tests

• Tzanck preparation
• characteristic uninucleate or multinucleate cells
• sensitivity
• 50-70 for vesicles
• less for crusted lesions
• specificity
• cannot be distinguished from varicella zoster

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HSV Direct detection tests

• EIA tests
• sensitivity
• range from 35-99
• varies with tests used, collection site, stage of
  lesion
• specificity
• 99-100

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HSV Serologic tests

• Useful to determine immune status
• Not useful in documenting infection
• most individuals have antibody

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Syphilis

• Treponema pallidum never grown artificially
• Incidence
• increased in late 1980s - early 1990s
• now decreasing except in large urban areas and in
  the rural south
• Infection by direct contact only
• Incubation period for 1º syphilis
• 3 weeks, ranges from 10 - 90 days

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Primary Syphilis

• one or more painless chancre
• indurated ulcer
• may go unnoticed by patient/family
• chancre occurs at the site of inoculation

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Secondary Syphilis

• 6 wk. - 6 mo after 1º lesion
• Clinical manifestations
• polymorphic rash, often M-P on palms/soles
• condylomata lata around anus or vulva
• hypertrophic, papular lesion
• systemic systems
• lymphadenopathy, fever, malaise, splenomegaly,
  sore throat, H/A, arthralgias, CNS involvement
• Resolves in 4 - 12 weeks

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Tertiary Syphilis

• Occurs up to 15 years after primary lesion
• Clinical manifestations
• aortitis
• neurosyphilis
• gummatous changes of skin, bone, viscera

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Syphilis

• Diagnosis beyond the newborn period
• almost certain sexual transmission
• Diagnosis may be missed if testing is not
  repeated 1-3 months after contact
• Diagnosis is based
• dark field examination
• non-treponemal tests
• treponemal tests

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Syphilis diagnosis

• Dark field examination for spirochetes
• must be done on fresh material
• Non-treponemal tests
• VDRL, RPR, ART
• measures disease activity
• negative early in disease, latent acquired
• false positive mono, TB, varicella, hepatitis,
  pregnancy, connective tissue diseases, others
• prozone phenomenon large amounts of antibody

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Syphilis diagnosis

• Treponemal tests
• FTA-ABS, MHA-TP, EIA IgG and EIA IgM
• used to confirm positive non-treponemal test
• remains positive for life
• false positive
• yaws, pinta, leptospirosis
• rate bite fever, Lyme disease

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1º 2º Syphilis treatment

• Benzathine penicillin G IM
• 50,000 Units/kg x 1 (up to 2.4 million units)
• other options
• tetracycline 500mg qid x 2 weeks
• doxycycline 100mg bid x 2 weeks
• less effective
• ceftriaxone x 10 days
• erythromycin x 14 days