Outcome of multiagency investigation for gonorrhoea and chlamydia in prepubertal children: a retrospective review.

Abstract

Objective: To review the process and outcomes of multiagency investigation of gonorrhoea and chlamydia in prepubertal children.

Design: Retrospective review of cases presenting to a hospital multidisciplinary child protection team (CPT).

Setting: A multiagency centre adjacent to Starship Children's Hospital, in the city of Tāmaki Makaurau Auckland, Aotearoa New Zealand. The hospital CPT is colocated in this centre with statutory child protection services (CPS), police and forensic interviewers.

Participants: All prepubertal children seen with gonorrhoea or chlamydia from 2009 to 2020.

Results: There were 16 children aged 1 to 9 years: 10 with Neisseria gonorrhoeae (NG), 2 with NG and Chlamydia trachomatis (CT) and 4 with CT. Ten presented with vaginal discharge, and four with conjunctivitis. Aside from their infection, 14 had normal examinations. CPT practice varied with respect to history taking, medical tests and follow-up. Urine screening identified at least one positive household member in 14 children. Sexual abuse was substantiated by CPS in 2/4 children with conjunctivitis and 11/12 others. Five children disclosed in forensic interviews, contributing to four criminal convictions: three for rape (penile penetration of the genitalia) and one for indecent assault. None of these four children had anogenital injuries.

Conclusions: Prompt, thorough and coordinated multiagency investigation of prepubertal NG and CT infection (including household screening and expert interviewing of children) will often identify the source of infection and almost always establish sexual transmission. However, even in a tertiary centre, cases are rare, leading to variability in practice. Conjunctivitis caused by NG or CT has a high risk of being sexually transmitted, so should be investigated with the same rigour as anogenital infection. Findings in this cohort, where penetrative sexual offences were confirmed by criminal convictions, support the international consensus that penetrative sexual abuse of children seldom causes anogenital injury.