Appropriate use of nonculture tests for the detection of sexually transmitted diseases in children and adolescents.
The introduction of nucleic acid amplification tests (NAATs) has been the most important advance in the diagnosis of sexually transmitted diseases (STDs) since tissue culture replaced inoculation of eggs for culture and isolation of Chlamydia trachomatis from clinical specimens. Because nucleic acid amplification is exquisitely sensitive, theoretically capable of detecting as little as a single gene copy, and highly specific, it offers the opportunity to use noninvasive sampling (ie, urine). This ability in turn means that these tests might be used in nontraditional settings, such as schools and in the field, which may be very helpful in providing services to homeless adolescents. However, none of these tests is approved or recommended by the manufacturers for rectal specimens from adults, and they are not approved for rectogenital specimens from children. In addition to medical implications, the identification of a sexually transmitted disease (STD), especially in a young child, also has legal implications. Because of the legal implications, the highest specificity is needed and is more important than is sensitivity in this situation. Data on the use of these tests in prepubertal children are insufficient to permit their use at this time. What may be appropriate for screening a sexually active adult in an STD clinic may not be appropriate for evaluating a child victim of suspected sexual abuse. Although missing possible sexual abuse is a major concern, the ramifications of a false-positive test for an STD, which can lead to erroneous reports of sexual abuse and possibly unjustified prosecution and incarceration, also must be considered.
Division of Infectious Diseases, Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY 11203-2093, USA.
Margaret R
MR
Hammerschlag
D000293:Adolescent; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis; D002690:Chlamydia Infections / Q000175:diagnosis*; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D021141:Nucleic Acid Amplification Techniques / Q000379:methods / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*