General Medical Information

Gonococcal Infection

Michele D. Wilson

In contrast to the mature woman in whom the acidic, estrogenized vagina is inhospitable to gonorrhea and the cervix is the primary site of gonococcal infection, the vagina is the site of infection in the prepubertal child. Before approximately 9 or 10 years of age, the endocervix is closed and, therefore, upper tract extension is extremely rare. Gonococcal vaginitis usually is manifested by a copious, green, purulent vaginal discharge. Severe vulvitis can occur secondary to irritation from the discharge. The child may complain of pruritus or dysuria. Proof of infection by a positive culture is essential. Furthermore, an appropriate laboratory must confirm positive culture results for Neisseria gonorrhoeae in a prepubertal child. False-positive results have occurred due to misidentification of nonpathogenic Neisseria species and may have serious negative consequences. The recommended treatment for N. gonorrhoeae is a single intramuscular injection of ceftriaxone 125 mg for a child weighing less than 45 kg. Children weighing 45 kg or more should be treated with one of regimens recommended for adults.

The American Academy of Pediatrics has stated that physicians should assume that if a child has gonorrhea, she acquired it sexually and presumably abusively. Gonorrhea, outside the newborn period, is transmitted through sex play, sexual abuse, or sexual intercourse. When anogenital gonorrhea is found in a prepubertal girl, a thorough evaluation coupled with reporting to the appropriate authorities for sexual abuse must ensue. A complete search for adult contacts should be undertaken. Siblings of the index case should be examined and cultured. It is crucial to provide for the child’s safety while the investigation is proceeding. Gonococcal infection has been diagnosed in 3% to 20% of sexually abused children in various series.