Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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ORIGINAL ARTICLE
Year : 2007  |  Volume : 28  |  Issue : 2  |  Page : 76-78
 

Profile of sexually transmitted diseases in pediatric patients


1 Department of Zoology and Biomedical Technology, Gujarat University, Ahmedabad, India
2 Department of Skin and V.D., B.J. Medical College and Civil Hospital; Department of Zoology and Biomedical Technology, Gujarat University, Ahmedabad, India
3 Department of Skin and Venereal Diseases, Kesar SAL Medical College, Ahmedabad, India

Correspondence Address:
Kavina K Burzin
Department of Zoology and Biomedical Technology, Gujarat University, Ahmedabad - 380 009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7184.39008

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   Abstract 

Sexually transmitted diseases (STDs) are an important cause of morbidity in pediatric patients. The purpose for carrying out the present study is to study the clinico-epidemiological profile of pediatric patients attending the STD clinic of Civil Hospital Ahmedabad. Out of total 1870 patients with various STDs, 37 (1.98%) were children below 15 years of age. Males comprised of 29 (78.4%) cases. The majority of the patients 26 (70.3%) with STDs belonged to the age group of 11-15 years. Herpes progenitalis was the most common STD reported in 35.1% of cases, followed by syphilis (32.4%), and condyloma acuminata (10.8%). History of homosexual contact was reported in 43.2% of cases while child sex abuse (CSA) was reported in 27% of cases. Two cases were seropositive for HIV.


Keywords: Child sex abuse, HIV, pediatric STDs


How to cite this article:
Burzin KK, Parmar K S, Rao M V, Bilimoria F E. Profile of sexually transmitted diseases in pediatric patients. Indian J Sex Transm Dis 2007;28:76-8

How to cite this URL:
Burzin KK, Parmar K S, Rao M V, Bilimoria F E. Profile of sexually transmitted diseases in pediatric patients. Indian J Sex Transm Dis [serial online] 2007 [cited 2020 Aug 14];28:76-8. Available from: http://www.ijstd.org/text.asp?2007/28/2/76/39008



   Introduction Top


Sexually transmitted diseases (STDs) are an important cause of morbidity and mortality. With the evolution of the HIV/AIDS epidemic, there is a renowned interest in the field of STDs as they can increase a person's risk of acquiring and transmitting HIV by many folds. Moreover, STDs are also an important marker of a person's high-risk sexual behavior.

All STDs occurring in adults can be transmitted to children. However, the pattern of transmission may vary. In children, it can occur either during intrauterine or perinatal period, by sexual abuse, or by voluntary sexual contact. In children between 2 and 10 years of age, sexual abuse is the first possible way of transmission. [1] Child sex abuse (CSA) is a hidden pediatric problem [2] and is also becoming one of the important factors for acquiring STDs including HIV.

Till now no exclusive studies have been conducted on Pediatric STD, particularly from Western part of India. This study highlights the pattern of various STDs and HIV along with the sexual behavior in patients of pediatric age group.


   Materials and Methods Top


All patients who were below 15 years of age having STDs were studied during 4-year period starting from January 2002 to December 2005. The patients were interviewed according to a structured questionnaire that contained details about epidemiological data, sexual behavior of the patients including homosexual/bisexual behavior. Clinical diagnosis was followed by relevant laboratory investigations.

Rapid plasma reagin (RPR) card test was done in all patients to rule out syphilis. Gram staining was done in cases of urethral discharge for gonorrhoea. All patients were screened for concomitant HIV infection by ELISA method using Enzaids HIV1+2 ELISA test kit (Span Diagnostics Ltd., Surat). Patients tested positive for HIV were confirmed again by CombAids-Recombinant and Synthetic peptide (RS) method (Span Diagnostics Ltd., Surat) followed by Rapid Tridot method (J. Mitra and Co. Ltd., New Delhi).


   Results Top


A total of 1870 patients with various STDs were studied from January 2002 to December 2005. Out of which 37 cases (1.98%) were children who were 15 years or below. Males comprised of 29 (78.4%) cases while females comprised of 8 (21.6%) cases. Male to female ratio was 3.6:1. The majority of the cases 26 (70.3%) were in the age group of 11-15 years [Table - 1]. In the present study, history of homosexual exposure was reported in 16 (43.2%) cases, followed by forcible case of abuse reported in 10 (27%) cases [Table - 2].

The distribution of various STDs is shown in [Table - 3]. Herpes progenitalis was the most common STD reported in 35.1% of cases, followed by syphilis in 32.4% of cases. Two cases were seropositive for HIV; one female had secondary syphilis (S 2 ) and another male had mixed STDs (condyloma acuminata + molluscum contagiosum).

Genitals were the most common site of involvement of lesions reported in 21 (56.8%) cases, followed by anal lesions reported in 9 (24.3%) cases. Genito-anal involvement was reported in 5 (13.5%) cases while body lesions were observed in 2 (5.4%) cases of secondary syphilis.


   Discussion Top


The incidence of childhood STDs in the present study was 1.98%. Similar studies by Pandhi et al. [3] and Mendiratta et al. [4] reported childhood STDs in 0.82% and 2.5%, respectively.

In the present study 78.4% were males, and male to female ratio was 3.6:1. Similar studies by Bhogal et al. [5] and Pandhi et al. [6] reported 58% and 63.8% male patients, respectively.

The peak incidence of STDs was seen in the age group of 11-15 years which accounted for 70.3% of cases which is similar to studies by Bhogal et al. [5] and Pandhi et al. , [3] who reported STDs in 66% and 66.1%, respectively, but higher compared to the study by Mendiratta et al. , [4] who reported in 41.2%. All these studies point to the fact that STDs are increasingly seen commonly among the adolescents. Early-onset of sexual activity along with homosexual and bisexual behavior increases the chances of acquiring STDs including HIV at an early age.

History of homosexual contact was reported in 16 (43.2%) cases. Out of 16 males, 14 males were above 11 years of age. A study by Mendiratta et al. [4] reported that homosexuality was in 11.11% of cases. History of forcible abuse was elicited in 10 (27%) cases of which 7 were males and 3 were females. This was higher compared to the study by Mendiratta et al. , [4] who reported child abuse in 17.6% of cases, but lower compared to the studies by Bhogal et al. [5] and Pandhi et al. , [3] who reported child abuse in 60% and 74%, respectively. One male of 10 years and one female of 15 years were HIV positive and both were victims of child abuse. Thus child abuse is one of the important markers for STDs and HIV in pediatric patients. [7]

In the recent years, there has been a shift in the pattern of STDs from bacterial to viral with herpes progenitalis being the most common viral STDs. In the present study also it is one of the commonest STD seen in pediatric patients accounting for 13 (35.1%) cases. Out of nine males with genital herpes, history of homosexuality was reported in five cases, two cases were of child abuse, one was bisexual while one denied any history of exposure. Out of four females, two were 18 months old and both were cases of child abuse. Other two females had exposure with known persons.

Syphilis was the second most common STD reported in 12 (32.4%) cases including one case of congenital syphilis in 1-year-old female child. Out of nine males with syphilis, homosexual exposure was reported in four cases, three cases were of child abuse, one was bisexual and, one had exposure with a commercial sex worker (CSW). Out of three females, one was a case of child abuse, one had perinatal transmission, and one denied any history of exposure.

Condyloma acuminata (genital warts) was reported in four (10.8%) cases (three males and one female). Out of three males, one was a forcible case of child abuse, one was homosexual, and one had exposure with known person. In a single case of female patient with warts information regarding the mode of transmission could not be elicited.

Mixed STDs were found in two (5.4%) males. One had condyloma lata (S 2 ) with chancroid. This patient was a 13-year-old male who had history of receptive homosexual exposure with multiple (three) male partners. While another boy of 10 years age was a forcible case of CSA. This patient had perianal lesions of condyloma acuminata and molluscum contagiosum, and was also HIV positive.

The incidence of gonorrhoea was 5.4% in the present study. Both the patients were males, one had homosexual exposure and other had exposure with a stranger.

Chancroid, nongonococcal urethritis, molluscum contagiosum, and balanoposthitis comprised of one case each in the present study. All the four cases were males having a history of homosexual exposure. No case of vaginal discharge (candidiasis), granuloma inguinale, or lymphogranuloma venereum was observed in the present study.

Two cases (5.4%) in the present study were seropositive for HIV. One male of 10 years of age had perianal lesions of condyloma acuminata and molluscum contagiosum and one female of 15 years had secondary syphilis as STD. Both were forcible cases of abuse.


   Conclusion Top


Sexual promiscuity in general, sexual assault in particular, was probably the most common reason for the presence of STDs including HIV in children. Early-onset of sexual activity, lack of knowledge about the disease, practices of high-risk homosexual/bisexual behavior with multiple partners, and child abuse increase the risk of acquiring STDs and HIV.

 
   References Top

1.Hadlich SF, Kohl PK. Sexually transmitted diseases in children: A practical approach. Dermatol Clin 1998;16:859-61.  Back to cited text no. 1  [PUBMED]  
2.Kempe CH. Sexual abuse, another hidden pediatric problem: The 1977 C Anderson Aldrich Lecture. Pediatrics 1978;62:382-9.  Back to cited text no. 2  [PUBMED]  
3.Pandhi D, Kumar S, Reddy BS. Sexually transmitted diseases in children. J Dermatol 2003;30:314-20.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Mendiratta V, Harjai B, Koranne RV. Profile of STDs in children: A retrospective hospital based study from Delhi. Indian J Sex transm Dis 2004;25:67-9.  Back to cited text no. 4    
5.Bhogal CS, Chauhan S, Baruah MC. Pattern of childhood STDs in a major hospital of East Delhi. Indian J Dermatol Venerol Leprol 2002;68:210-2.  Back to cited text no. 5    
6.Pandhi RK, Khanna N, Sekhri R. Sexually transmitted diseases in children. Indian Pediatr 1995;32:27-30.  Back to cited text no. 6  [PUBMED]  
7.Hanson RM. Sexually transmitted diseases and sexually abused child. Curr Opin Pediatr 1993;5:41-9.  Back to cited text no. 7  [PUBMED]  



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]



 

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    Abstract
    Introduction
    Materials and Me...
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