Pediatric emergency medicine trisk 1113 1113
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transmitted infections (STIs), a common cause of dysuria in adolescents ( Figs.
57.1 and 57.2 ).
Urethral or vaginal discharge suggests an infection of the genitalia: urethritis in
the boy and urethritis or vulvovaginitis in the girl (see Table 57.3 ). To evaluate
the cause of discharge when there is concern for STI in prepubertal children, noninvasive methods of testing should be considered. Nucleic acid amplification tests
(NAATs), which use ligase chain reaction (LCR) or polymerase chain reaction
(PCR) technologies, can be performed on first-catch urine (not clean-catch) to test
for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae in a
noninvasive manner. They may also be used to test for the presence of
Trichomonas vaginalis in both males and females. NAATs are considered the gold
standard in STI testing for postpubertal patients. These tests may be considered
an accurate screening tool for STIs and do not require obtaining cervical or male
urethral swabs. Self-collected vaginal swabs from adolescent female patients can
also be used for testing and offer similar accuracy when compared with providerobtained cervical specimens. In cases of suspected abuse, a urethral or vaginal
culture may be required by local law enforcement agencies as all do not accept
NAAT testing. Treat postpubertal patients in the ED; treatment in young children
is based on presence of symptoms and clinical findings after all needed testing
has been collected for medical–legal documentation. For recommended treatment
regimens, see Chapter 92 Gynecology Emergencies .
