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Letters to the Editor

Sexual abuse and herpetic genital infection in children To the Editor: The recent clinical note by Shturman-Ellstein and associates ~is interesting in that it reminds us of a rare but significant complication of a disease which is seen infrequently in c h i l d r e n genital herpes. I would like to ask whether the authors were able to elicit any historical data to explain the origin of the genital infection. In particular, was there any evidence o f sexual abuse of this child? The authors quote the article of Nahmias and associates, ~ which presented six cases of genital herpesvirus infection in children. In the series only two of the six cases were felt to have been acquired nonsexually. Nahmias and associates also stated that "the evidence at present suggests that most cases of genital hepetic infection are sexually transmitted. ''2 It behooves those of us who see genital infections in children to be aware of the possibility o f sexual abuse in spite of the absence of a clear history. Many o f us know apocryphal stories about, or have h a d clinical experience with, bizarre physical findings or behavior disturbances in children which upon careful evaluation have proven to be related to sexual abuse. Nobody has stated the fact better than SgroP: "Recognition of sexual molestation in a child is entirely dependent on the individual's inherent willingness to entertain the possibility that this condition may exist."

Arthur C, Jaffe, M.D. Instructor, Department of Pediatrics University of Minnesota Medical School Staff Physician Department of Pediatrics Hennepin County Medical Center Fifth & Portland South Minneapolis, Minn. 55415 REFERENCES

1.

Shturman-Ellstein R, Borkowsky W, Fish I, and Gershon AA: Myelitis associated with genital herpes in a child, J PEDIATR 88:523, 1976. 2. Nahmias A J, Dowdle WR, Naib M, Josey WE, and Luce CF: Genital infections with herpesvirus hominis types 1 and 2 in children, PEDIATRICS 42:659, 1968. 3. Sgroi S: Sexual molestation o f children: The last frontier of child abuse, Children Today 4:18, 1975.

Reply To the Editor: Space did not permit us to mention the social circumstances concerning the young girl we recently described with myelit!s and genital herpes. Actually the girl's mother brought her to the hospital because she suspected sexual abuse. No evidence of abuse was noted on gynecologic examination, however, and the girl consistently denied any sexual encounters. Since in addition

The Journal of Pediatrics August 1976

HSV I not HSV II caused the genital lesions, the likelihood of sexual transmission seemed unlikely in our patient. We certainly agree with Dr. Jaffe that a thorough search to rule out sexual abuse is indicated in children with illnesses which are potentially transmitted by venereal means.

Anne A. Gershon, M.D. Associate Professor Irving Fish, M.D. Associate Professor William Borkowsky, M.D., Fellow, Infectious Diseases New York University Medical Center School of Medicine 550 First Ave. New York, N.Y. 10016

More on the importance of early recognition and treatment of saltlosing congenital adrenal hyperplasia To the Editor: In the February issue of THE JOURNAL OF PEDIATRICS S. H. Silverman and W. L. Nyhan ~ reported two cases of shock following intravenous pyelography in patients with congenital adrenal hyperplasia. As mentioned by the authors, management o f these patients was far from optimal, owing to lack of experience of many physicians with adrenal hyperplasia and owing to delay in definite diagnosis. We should like to report our own recent experience with a female newborn infant who was admitted to our hospital because of a large clitoris. Congenital adrenal hyperplasia was suspected and an ACTH-test for differential diagnosis was performed. However, before the results of analyses were available, the p a t i e n t - w h o had done perfectly well until t h e n - b e g a n to lose weight on the tenth day of life; serum electrolyte concentrations were normal, but metabolic acidosis (pH 7.26, BE-12.5) was present. She was treated with intravenous fluids and cortisone acetate and DOCA and recovered quickly; the next day, congenital adrenal hyperplasia was confirmed by the results of 17-a-hydroxyprogesterone assay in blood and analysis of 17ketosteroids and pregnanetriol in urine. From the cited authors' and our own experience we suggest initiation of therapeutic measures even before the eventual diagnosis o f congenital adrenal hyperplasia is established.

Dr. Peter Koepp Childrens Hospital University of Hamburg/ GFR Martinistr. 52 D-2 Hamburg 2o Germany

Letter: Sexual abuse and herpetic genital infection in children.

338 Letters to the Editor Sexual abuse and herpetic genital infection in children To the Editor: The recent clinical note by Shturman-Ellstein and a...
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