In Reply.—I appreciate the thoughtful comments of Drs Jason and Kramer. I will try to respond to their concerns.
The respondents are correct in that the three studies of sexual abuse in children with gonococcal disease are somewhat disparate. My purpose in combining the studies was simply to emphasize that the physician should strongly suspect sexual activity in a child who has gonorrhea.
The question of whether to provide gonorrhea prophylaxis after rape is more difficult. The reported incidence in the United States of gonorrhea in children who have been sexually abused varies from 4.7% to 7.4%.1,2 The infrequent occurrence of gonorrhea in these children must be weighed against the potential psychologic disaster for the infected child and his or her parents. A satisfactory method of rapid identification of the presence of gonococci, currently under investigation, would alleviate this dilemma.
Finally, I agree completely with the statement that
JONES JG. Sexual Child Abuse-Reply. Am J Dis Child. 1982;136(12):1098. doi:10.1001/archpedi.1982.03970480063018