Gonococcal Infections Among Infants and Children
Sexual abuse is the most frequent cause of gonococcal infection among infants and children (see Sexual Assault or Abuse of Children). For preadolescent girls, vaginitis is the most common manifestation of this infection; gonococcal-associated PID after vaginal infection can be less common among preadolescents than adults. Among sexually abused children, anorectal and pharyngeal infections with N. gonorrhoeae are frequently asymptomatic.
Diagnostic Considerations
Culture can be used to test urogenital and extragenital sites for girls and boys. NAAT can be used to test for N. gonorrhoeae from vaginal and urine specimens from girls and urine for boys (see Sexual Assault or Abuse of Children). Although data regarding NAAT from extragenital sites (rectum and pharynx) among children are more limited, and performance is test dependent, no evidence supports that performance of NAAT for detection of N. gonorrhoeae among children differs from that among adults (553). Because of the implications of a N. gonorrhoeae diagnosis in a child, only validated FDA-cleared NAAT assays should be used with extragenital specimens. Consultation with an expert is necessary before using NAAT to minimize the possibility of cross-reaction with nongonococcal Neisseria species and other commensals (e.g., N. meningitidis, Neisseria sicca, Neisseria lactamica, Neisseria cinerea, or M. catarrhalis) and to ensure correct interpretation of results.
Gram stains are inadequate for evaluating prepubertal children for gonorrhea and should not be used to diagnose or exclude gonorrhea. If evidence of DGI exists, gonorrhea culture and antimicrobial susceptibility testing should be obtained from relevant clinical sites (see Disseminated Gonococcal Infection).
Ceftriaxone 25–50 mg/kg body weight IV or IM in a single dose, not to exceed 250 mg IM
Treat with the regimen recommended for adults (see Gonococcal Infections)
Ceftriaxone 50 mg/kg body weight (maximum dose: 2 g) IM or IV in a single dose daily every 24 hours for 7 days
Ceftriaxone 1 g IM or IV in a single dose daily every 24 hours for 7 days
Other Management Considerations
Follow-up cultures are unnecessary. Only parenteral cephalosporins (i.e., ceftriaxone) are recommended for use among children. All children identified as having gonococcal infections should be tested for C. trachomatis, syphilis, and HIV (see Sexual Assault or Abuse of Children).