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The diagnosis of gonorrhea and/or chlamydia in a pre-pubertal children beyond the neonatal period is confirmatory of mucosal contact with infective bodily secretions and therefore highly concerning for sexual abuse. When such a diagnosis is made, a report to protective authorities is warranted so that safety and potential criminal activity may be evaluated concurrent with the medical management. Occasionally, despite perceived adequate medical management and protective safety plans, a child may present with a repeat positive result for sexually transmitted infections. In this scenario it is important for medical providers to carefully consider and be aware of the possible reasons for the repeat positive result which include: 1) treatment failure; 2) a new infection from repeated abuse; or 3) a falsely positive result due to the limitations of non-culture testing.
Pre-pubertal sisters were diagnosed with gonorrhea and chlamydia, treated with antibiotics, and the individual identified as having sexually abused them was removed from the home. Over a four month period, both continued to have positive testing for chlamydia via Nucleic Acid Amplification Test (NAAT) and/or culture. Concurrent to utilizing alternate antibiotic treatment options, protective authorities were alerted to the fact that this was likely a re-infection. The investigative team later determined that a second adult, who tested positive for gonorrhea and chlamydia, was also sexually abusing both girls. Disclosures of abuse regarding both adult individuals were deemed credible by authorities and supported with collateral information.