Genital Infection In Infants / Children Flashcards
Why is neonatal chlamydia infection important?
A significant cause of neonatal morbidity.
Can cause ophthalmia neonatorum and pneumonia
Mode of transmission of chlamydia to neonates
By direct contact with the infected maternal genital tract
What anatomical sites may be involved in neonatal chlamydia infection?
Eyes
Oropharynx
Urogenital tract
Rectum
What is the usual timeframe for the development of neonatal chlamydial conjunctivitis?
5–12 days after birth
What is the usual timeframe for the development of neonatal chlamydial pneumonia?
1 -3 months after birth
Why is neonatal chlamydial infection much less common now than previously? b
Increased screening of pregnant women
Increased treatment of pregnant women
How is neonatal chlamydia infection diagnosed?
Most frequently made on clinical grounds
Confirmed with NAATs testing - not validated but widespread use + should be effective
What sample should be taken to diagnose neonatal chlamydial conjunctivitis
NAATs specimen obtained from the everted eyelid
Use a dacron-tipped swab
or swab specified by manufacturer’s test kit
Should contain conjunctival cells
Not exudate alone
Specimen should also be tested for N. gonorrhoeae.
What sample should be taken to diagnose neonatal chlamydial pneumonia?
NAATs specimens collected from the nasopharynx.
Do not use NAATs for Chlamydophila pneumoniae as these DO NOT detect chlamydia trachomatis.
Treatment of neonatal chlamydia
Erythromycin PO 50mg/kg/day in four divided doses for 14 /7
(topical treatment is inadequate)
Alternative = Azithromycin 20mg/kg/day PO OD for 3/7
Why is ceftriaxone not licensed to be given to neonates under 41 weeks postmenstrual age
risk of precipitation in urine and lungs
What is the recommended medication for treating uncomplicated gonorrhoea in neonates under 41 weeks postmenstrual age
IV Cefotaxime
Expert paediatric advice is required regarding dosage
AVOID ceftriaxone under 41 weeks postmenstrual age
Recommended treatment for uncomplicated gonorrhoea in children aged 1 month to <2 years
Ceftriaxone 125mg IM STAT in children who weigh < 45kg
or Spectinomycin 40 mg/kg IM STAT [unreliable in pharyngeal infection]
Recommended treatment for uncomplicated gonorrhoea in children aged 2 to 12 years
Ceftriaxone
If <45kg - give 125mg IM STAT
If >45kg - give 250mg IM STAT
Recommended treatment for uncomplicated gonorrhoea in children aged >12 years
Ceftriaxone 500mg IM STAT plus Azithromycin 1g PO STAT
**Guideline last updated 2013** - can't find new evidence re dosing
or Cefixime 400mg po stat (unlicensed) if patient refuses IM treatment/needle phobic
plus Azithromycin 1g po stat
Treatment of gonococcal PID in a child aged 2 -12 years
Ceftriaxone 125mg IM STAT - if weighing < 45 kg
AND Erythromycin 250mg BD PO 2/52
AND Metronidazole BD PO (dose by weight) 2/52
Treatment of gonococcal PID in a child aged 2 -12 years
Ceftriaxone 500mg IM STAT
AND Doxycycline 100mg BD PO 2 weeks
AND Metronidazole 400mg BD PO 2 weeks
What are the recommendations by BASHH for staff seeing under 16s in sexual health services?
Assess competence and risk factors re-assessed at each visit with a new problem
Assess for risk factors for Child Sexual Abuse and exploitation
Use an ‘under-age attender proforma’
Give the YP opportunity to be seen alone
Encourage them to involve a parent / carer
Referr to a Health Adviser
STI screening and prevention advice
+/- STI diagnosis and treatment
Contraceptive advice
Factors influencing the risk of infection in children and young people
- prevalence of STIs in the local population
- maternal STI during pregnancy - vertical transmission
- type of sexual activity
- injuries of the genital tract increase susceptibility
- sexual maturity - young people have increased
biological susceptibility to carcinogens and STIs due to physical and immunological immaturity of the genital tract - lack of use of barrier contraception.
- age at first intercourse
- previous sexual activity
- increased number of partners.
- co-existing other risk behaviours - drugs or alcohol
Sample site suggested for STI screening in pre-pubertal girls
introital swabs inside labia minora
but avoiding the hymen
Trans-hymenal swabs can be used if it is possible to pass a swab without causing distress. (ENT swabs are smaller than traditional swabs)
First-pass urine - GC and CT NAAT - if swabs are not feasible
Sample site suggested for STI screening in pre-pubertal boys?
First-pass urine - NAAT for GC and CT
Meatal swab - If urethral discharge
Management of infants and children of HIV positive parents
Test children born to HIV positive parents - irrespective of their age if they may be at risk
Requires parental consent
If a parent refuses testing of the child - seek specialist advice
Significance of gonorrhoea in children
- Gonorrhoea is not often seen in pre-pubertal and pubertal children
- Consider the possibility of sexual abuse
- Consider the possibility of vertical transmission
- Gonorrhoea is more likely to be due to sexual abuse in older children
- Consider consensual sexual activity in adolescents
Significance of chlamydia in children
- Consider the possibility of sexual abuse
- Consider the possibility of vertical transmission
- CT more common in pubertal than pre-pubertal sexually abused girls
- But also consider consensual sexual activity in adolescents
