Prepubertal gonorrhea: a multidisciplinary approach.
Forty-six children less than 12 years of age with gonorrhea were studied over a 4 1/2-year period. The investigation was conducted by a multidisciplinary team including physicians, social workers, and health department representatives. Extensive interviewing and routine culturing of contacts eventually identified the source of gonorrhea in 38/46 (83%) children. Males, both adult and preadolescent, were implicated as the source of gonorrhea almost twice as often as the child's mother. Nineteen children were victims of sexual assault, but only four of them had a hymenal orifice larger than one fingerbreadth. Compliance, both in pursuing the history and obtaining cultures of contacts, was significantly increased by admission to the hospital. A Gram stain and culture for gonorrhea should be done in all children presenting with vaginal discharge regardless of history. Hospitalization of children with suspected gonorrhea greatly facilitates the contact identification.