Vulvovaginitis, the gonococcus, and child abuse - abstract

ABSTRACT

Records of 424 girls under 12 years of age, who presented consecutively to University Hospital of the West Indies with a history of vaginal discharge, were kept on an on-going basis in a separate register for one year from November, 1983. The vaginal swabs showed non-specific flora in 49 percent, N. gonorrhoea in 14 percent, S. pneumoniae in 8 percent, H. influenzae Type B in 5 percent, C. albicans in 3 percent, other organisms in 13 percent, and unknown or culture negative results in 5 percent. Of the 58 children with gonorrhoea, 52 percent were under 6 years of age. Information available on 60 percent of these revealed possible sexual contact in 36 percent. Forty per cent of these were reportedly incestuous (father, brother, uncle, cousin), 30 percent involved step-father or mother's consort, and 30 percent family friends or neighbours. These figures may be underestimates. This report documents the occurrence in this age group of S. pneumoniae (not previously reported), N. gonorrhoeae, C. albicans among near-pubertal girls, T. Vaginalis in the 2 to 10 year-olds, the hidden problem of intrafamilial child abuse, and condylomata acuminata as an unusual manifestation of child abuse. Attention is drawn to vulvovaginitis in the hope that a high index of suspicion and family investigations for child abuse, gonorrhoea and incest will be encouraged; that health education for parents and schools will include information specific to perineal hygiene and sexually transmitted diseases; and that the child population, affected as it is by the increasing incidence of adult gonorrhoea, will be included in programmes for the control of this disease. The authors acknowledge with thanks the valuable assistance of the staff of their respective Departments (AU)