To the Editor.—
The article entitled "AMA Diagnostic and Treatment Guidelines Concerning Child Abuse and Neglect"1 provided a useful reference in this area. However, some errors of omission and commission, as well as some limitations in our current knowledge about the true prevalence of child abuse and neglect, should be noted.
Signs of Sexual Abuse.—
At times, the sexually abused child will be initially seen as a patient with urinary, genital, perineal, or anal symptoms. Since the diagnosis of sexual abuse is often dependent on a diagnosis of a sexually transmitted disease,2 it is important to include in this section, entities of proved sexual transmission and exclude or qualify less specific indicators.In the section entitled "Physical Signs of Sexual Abuse," recurrent urinary tract infections and candidiasis were included as possible indicators of sexual abuse. While these certainly can coexist with sexual activity, the frequent occurrence of these
Beck-Sague CM, Alexander ER, Jason JM. Child Abuse and Neglect. JAMA. 1986;255(9):1135. doi:10.1001/jama.1986.03370090057009