Faculty Bibliography

To increase their knowledge of the medical evaluation and reporting of child sexual abuse, medical students, pediatric resident physicians, fellows and attendings participated in an interdisciplinary team-based training program consisting of didactic lectures, case discussions, videotapes and direct participation in patient evaluation. Content focused on the medical knowledge and skills needed for an assessment of the child's interview, anogenital examination and the indications for case reporting to child protection authorities. We evaluated the results of this training in our outpatient child abuse clinic located in a university-affiliated, municipal hospital using a survey which assesses knowledge of female genital anatomy, sexually-acquired diseases and case reporting in a nonrandomized control trial. Fifteen medical students and pediatric physicians participated and were compared to a reference group of 127 participants who did not receive this training and 15 others who randomly repeated the survey instrument during the study period. The results showed that resident physicians demonstrated increased mean total scores in the survey instrument. We conclude that an interdisciplinary team using patient care exposure increases physician knowledge in the evaluation of child sexual abuse

A 1-year prospective study was undertaken of 65 prepubertal girls referred for evaluation of sexual abuse or vulvovaginitis to compare Chlamydiazyme, an enzyme immunoassay (EIA), with culture for the detection of Chlamydia trachomatis i in vaginal specimens. Five (8%) of 65 patients were initially EIA-positive. On repeat sampling without intervening antibiotic treatment, 4 girls who were initially positive became negative and 1 remained persistently positive. Chlamydial cultures were negative in all patients. The patient with the persistently positive EIA also had Group A streptococcal vaginitis. We were able to demonstrate that some strains of Group A Streptococcus can cause a positive reaction with the EIA. Cross-reactions with other bacterial species are also known to occur. We therefore conclude that Chlamydiazyme is not specific for the detection of chlamydial infection in the vagina of prepubertal girls and, for medicolegal reasons, should not be used for evaluation of sexual abuse