The diagnosis of gonorrhea and/or chlamydia in a prepubertal child beyond the neonatal period is confirmatory of mucosal contact with infective bodily secretions and therefore highly concerning for sexual abuse. When such a diagnosis is made, a report to protective authorities is warranted so that safety and potential criminal activity may be evaluated concurrent with the medical management. Occasionally, despite perceived adequate medical management and protective safety plans, a child may present with a repeat positive result for sexually transmitted infections. In this scenario, it is important for medical providers to carefully consider and be aware of the possible reasons for the repeat positive result: (1) treatment failure, (2) a new infection from repeated abuse, or (3) a false-positive result due to the limitations of nonculture testing.

Prepubertal sisters were diagnosed with gonorrhea and Chlamydia and treated with antibiotics, and the individual identified as having sexually abused them was removed from the home.

Over a 4-month period, both children continued to have positive testing for chlamydia via the nucleic acid amplification test and/or culture. Concurrent with using alternate antibiotic treatment options, protective authorities were alerted to the fact that this was likely a reinfection. The investigative team later determined that a second adult, who tested positive for gonorrhea and chlamydia, was also sexually abusing both girls. Disclosures of abuse regarding both adult individuals were deemed credible by authorities and supported with collateral information.