Pediatric emergency medicine trisk 2332 2332
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STIs are the most commonly reported infections in the United States and
represent an important pediatric problem, particularly during infancy or
adolescence. This chapter focuses on HIV, syphilis, HSV outside the neonatal
period, and neonatal chlamydia and gonorrheal infections and nongenital
gonorrheal infections. STIs causing pelvic inflammatory disease and cervicitis
are covered elsewhere (Chapter 92 Gynecology Emergencies ) and management
of STIs in the abused child is discussed in Chapter 87 Child Abuse/Assault . In
these children, the most common pathogens are Trichomonas, C. trachomatis,
and Neisseria gonorrhea, and one study in sexually abused girls found that 8%
of girls had one or more STIs. As many adolescents with one STI can be infected
with more than one pathogen, identification of one STI should prompt diagnostic
evaluation for others. The manifestations, diagnosis, and treatment of common
STIs are described in Table 94.22 .
Chlamydia, Neonatal
C. trachomatis can cause a number of syndromes in infants: conjunctivitis,
trachoma, and pneumonia. Chlamydia is the most common STI in the United
States, and adolescent females comprise the most at-risk group. Vertical
transmission occurs in up to 50% of infants born to infected mothers. Chlamydia
conjunctivitis is characterized by a serous, slightly purulent eye discharge that
can be first noticed within 5 days to several weeks after delivery. There is
conjunctival injection and lid edema. The drainage typically lasts 1 to 2 weeks.
Approximately 30% of children with neonatal chlamydia conjunctivitis also will
have chlamydial pneumonia. Chlamydia conjunctivitis and trachoma are not
prevented by erythromycin that is given in the immediate newborn period to
prevent ophthalmia neonatorum (see below). Trachoma is a sequela of chronic
chlamydial eye infection and is characterized by corneal neovascularization
which can result in blindness. While rare in the United States, trachoma is the
leading infectious cause of blindness globally, estimated to impact up to 80
million persons. C. trachomatis pneumonia occurs most commonly from 2
weeks to 5 months after birth and is characterized by an afebrile illness with
repetitive, paroxysmal cough similar to pertussis. In contrast to pertussis,
leukemoid reactions are rare, but eosinophilia can be seen. Upper respiratory
tract symptoms are common from chlamydial colonization of the nasopharynx.
Radiographic findings may include hyperinflation and patchy interstitial
infiltrates. The diagnosis is made on the basis of direct fluorescent antibody
(DFA) testing, the only FDA-approved test for the detection of C. trachomatis
from nasopharyngeal and conjunctival specimens. The treatment of chlamydia
