Pocket Pediatrics: The Massachusetts General Hospital for Children Handbook of Pediatrics (Pocket Notebook Series), 2 Ed.

SEXUALLY TRANSMITTED INFECTIONS

(CDC STD Treatment Guidelines, 2010)

cx, culture; SN, sensitivity; SP, specificity; CT, C. trachomatis; NG, N. gonorrhoeae; Rx, treatment; NAAT, nucleic acid amplification test; GNID, Gram neg intracellular diplococci.

Evaluation and Management of High-risk Exposure (Red Book 2009; 2010 Guidelines on HIV PEP beyond the perinatal period)

• Eval of & Rx for sexual assault should be managed by a multidisciplinary team that is experienced in the care of children or adolescents who have been sexually assaulted

• Diagnostic testing (within 72 hr of exposure and repeated at 2 wk)

• CT and GC urine NAAT or cervical culture; swab of throat and rectum if relevant to exposure

• HIV ELISA

• Wet prep for trichomonas and bacterial vaginosis if cervical exam performed

• Hepatitis B surface antibody if status of vaccination unknown

• Prophylaxis (recommended in all postpubertal , discuss w/ ID & sexual assault specialist & family in prebuteral children, typically only Rx for Sx, always after consent from appt care givers)

• Ceftriaxone 125 mg IM × 1 if <45 kg; 250 mg IM × 1 if >45 kg for Gonorrhea

• Metronidazole 2 g PO × 1 for trichomonas

• Azithro 1 gm PO × 1 for >45 kg; 20 mg/kg × 1 PO for <45 kg for Chlamydia

• Hep B: Immunoprophylaxis depends on type of exposure & immune status of exposed individual. Not all immunized patients respond to the vaccine at protective levels. Please consult the Red Book (HBV section) for details

• HIV: Risk of transmission after exposure is <0.3% from puncture wound from a needle in the community, 0.1% from receptive vaginal intercourse, and 0.5% after penile–anal sex exposure

• HIV: <36 hr since high-risk exposure and source is HIV-positive or unknown start Kaletra & Truvada (http://aidsinfo.nih.gov – National HIV consultation center 24 hr hotline: 1-888-448-4911)