What does Chlamydia trachomatis detection in a urogenital specimen from a young child mean

The notion that sexually transmitted infections (STIs) can be acquired through non-sexual means is a well-established meme in the public consciousness. The public toilet seat is the most commonly blamed vector. This is despite the lack of evidence for acquisition of STIs from toilet seats, and the ready availability of reputable advice to this effect.1 While the ‘toilet seat hypothesis’ is not currently regarded as supported by data, other modes of non-sexual acquisition of STIs, though rare, have been reported. Examples include pharyngeal gonorrhoea by sharing of confectionery,2 transmission of urogenital (UGT) gonorrhoea by sharing of a sex doll,3 and transmission of Trichomonas vaginalis via the fingers of a traditional healer in west Africa.4 This provides credibility to the notion that STI detection in UGT specimens from young children is not always a consequence of ‘conventional’ sexual contact or, for very young children, vertical transmission. Estreich and Forster5 reviewed relevant evidence and concluded that inferring the cause of an STI in a young child is a ‘complex subject’, with vertical transmission, child sexual abuse and accidental/fomite transmission all conceivable mechanisms. This begs the question that is critical to service providers: How strongly does the presence of an STI in a young child indicate sexual abuse? This dilemma remains a challenge.6 In individual cases, potential modes of non-sexual transmission may be invoked, and the plausibility of these can impact child protection and/or justice system responses. Incorrect interpretation has the potential for a child remaining in an unsafe environment, or conversely leading to a false conclusion that a crime has taken place, resulting in initiation of an investigation. The strong imperatives to avoid either of these errors can create instability in institutional responses, and inappropriate management …