Table 1
Incubation Periods,
Clinical Manifestations, Transmission, and Diagnosis of Sexually Transmitted
Diseases (STD’s)* |
| STD and
Organism(s) |
Incubation
Period |
Clinical
Manifestations |
Transmission
|
Diagnosis
|
|
Gonorrhea Neisseria gonorrhoeae |
3–5 days |
Vaginitis, urethritis, pharyngitis, proctitis.
Rare: Arthritis, conjunctivitis.
Most pharyngeal (throat) and rectal infections
and as many as 50% of vaginal infections in children may be asymptomatic.
|
Through
sexual contact.
Exception: Neonatal conjunctivitis is acquired
by the infant from his/her mother at delivery.
No evidence of transmission by fomites (i.e.,
via toilet seats, “dirty” towels, etc.).
|
Culture of N. gonorrhoeae using selective media with confirmation
by at least two different methods using different principles, e.g.,
sugar fermentation, enzyme substances, serological or DNA hybridization.
Use of DNA probes or other nonculture methods,
including Gram-stained smears or vaginal or urethral discharges,
is not recommended because other bacteria may be
misidentified as N. gonorrhoeae.
|
|
Chlamydial infections Chlamydia trachomatis |
5–7 days |
Most
prevalent sexually transmitted infection in the United States.
In adults and adolescents: Urethritis and mucopurulent
cervicitis, which can lead to pelvic inflammatory disease; however,
most infections in adults and children are asymptomatic.
|
Sexually, in children 3 years of age or older.
Perinatally acquired infection (mother-to- infant)
may last in the vagina and rectum for up to 3 years or longer.
No evidence of transmission by fomites.
|
Isolation
of the organism in tissue culture only with microscopic identification
of the characteristic inclusions with fluorescent antibody staining.
Nonculture methods, including enzyme immunoassays
(EIA’s), direct fluorescent antibody (DFA) tests, and DNA
probes, are not approved for use in rectal or genital sites in
children. Use at these sites has led to many false-positive tests.
|
|
Syphilis Treponema pallidum |
Primary
infection: 10–90 days, usually 3–4 weeks.
Secondary: 6 weeks–6 months after the
primary lesion heals.
|
Primary syphilis: Chancre, i.e., a painless ulcer at the site of inoculation
(penis, vulva, vagina, rectum, etc.). The chancre heals spontaneously
after 1–2 weeks.
Secondary syphilis: Diffuse rash, fever, enlarged
lymph nodes, mucous patches.
Latent syphilis: Asymptomatic, although positive
serological findings may persist for years.
|
Through sexual contact. The chancre and mucous patches are very infectious.
Infants may acquire congenital syphilis from
their mothers. The presentation is similar to secondary syphilis.
|
Identification
of T. pallidum in lesions by dark-field microscopy or by staining
with a fluorescein-conjugated monoclonal antibody.
The most common methods used are serological:
Rapid plasma reagin (RPR) test; Venereal Disease Research Laboratory
(VDRL)-reaginic antibody test; and fluorescent treponemal antibody-absorption
(FTA–ABS) test, a test for a specific anti-T. pallidum
antibody.
Positive results on an RPR or VDRL test in a
child who does not have a history of congenital syphilis.
RPR and VDRL test results will be negative after
effective treatment; FTA–ABS remains elevated for the lifetime
of the patient.
|
|
Trichomoniasis Trichomonas vaginalis |
5–28 days |
Vaginitis.
In males, infection appears to be asymptomatic,
but T. vaginalis may cause some cases of nonspecific urethritis.
|
Through sexual contact.
Has not been found in children 1 year of age or
older without history of sexual contact.
Infants can acquire infection from mother at delivery;
can cause vaginitis.
Perinatally acquired infection may persist for 6–9
months after birth.
No evidence of transmission by fomites.
|
Microscopic identification of the organism in vaginal fluid.
Culture methods may be more sensitive, but not widely
available.
The finding of trichomonads in urine collected
for another purpose is not sufficient for accurate diagnosis,
as the urine could be contaminated with T. hominis, a normal
inhabitant of the bowel that is not sexually transmitted.
|
|
Bacterial vaginosis (BV) Gardnerella vaginalis; Bacteroides
species and other anaerobic bacteria; and Mycoplasma hominis.
|
5–28 days |
BV is not really an infection, but a disturbance of the normal vaginal
flora, which is replaced by the organisms listed.
Clinically presents as gray, foul-smelling vaginal
discharge, but may be asymptomatic.
|
Through sexual and nonsexual contact.
Probably related to poor hygiene in some young children.
|
Microscopic identification of “clue cells,” which are epithelial
cells studded with bacteria in vaginal secretions; a positive “whiff”
or amine test, which is the release of a very characteristic fishy
odor when 10% potassium hydroxide (KOH) is added to the vaginal fluid;
and a vaginal fluid pH of >4.5.
The latter test should only be done in adolescents,
as there are no vaginal pH standards for prepubertal children.
Culture of G. vaginalis is not indicated
and is not diagnostic for BV. G. vaginalis can be normal vaginal
flora and has been isolated in 5–15% of normal children who have
not been abused.
|
Herpes
Herpes simplex virus (HSV), types 1 and 2 |
2–5 days |
Painful
vesicular lesions that become ulcers on the vulva, vagina, penis,
and perirectal area.
May be associated with inguinal lymphadenopathy
(disease of the lymph nodes in the groin) and fever.
|
Through
sexual contact.
Primarily HSV–2, although 10% of genital herpes
in adults can be due to HSV–1.
Young children with herpetic gingivostomatitis (herpetic
infection of the gum tissues), a primary, nonsexually acquired infection
due to HSV–1, may autoinoculate (infect themselves) in the genital
area. There should be a history of stomatitis (sores in the mouth)
in the previous 2 weeks.
|
Isolation
of the virus from the lesions.
There are no commercially available antibody tests
that will reliably differentiate between HSV–1 and HSV–2.
|
|
Condyloma acuminata, venereal warts Human papilloma
virus (HPV)
|
4–12 weeks, but may be clinically inapparent for up to 18 months.
|
Flesh- to purple-colored papillomatous growths in the anogenital region.
|
Sexually, perinatally, and probably, but rarely, nonsexually.
Major confounding variable is the long period after
infection before the lesions become visible to the naked eye, which
could be as long as 18 months.
|
Clinical.
HPV
DNA-typing of the lesions is not generally available. |
AIDS
Human immunodeficiency virus (HIV) |
Seroconversion: 6 weeks after exposure; more than 90% of individuals
will be HIV positive by 6 months. Development of AIDS: 5– 10
years. |
Children
who are HIV positive before developing AIDS are asymptomatic.
Some individuals develop an acute retroviral syndrome,
similar to influenza, with lymphadenopathy after infection.
Has not been described in children with acquired
HIV infection.
|
Sexually, perinatally, and via blood transfusion, intravenous drug
abuse (IVDA), and sharing needles.
Approximately 30% of infants born to HIV-positive
mothers will develop HIV infection but may not develop clinical AIDS
for 5 years or longer.
Acquisition by sexual abuse needs to be differentiated
from perinatal infection, as risk factors for maternal infection and
sexual abuse are similar.
|
Serological: Presence of HIV antibody, detection of p24 antigen. Child
being evaluated for HIV after abuse needs to be tested for 6 months.
Consider HIV testing if the child is from an area of high HIV prevalence,
if the abuser is in a high-risk group (e.g., IVDA, crack user), or
if another STD is present. |
