Objective: There has been some debate about the modes of transmission of genital gonorrhoea in pre-pubertal children. Our objective was to determine, in a consecutive case series from one hospital, what modes of transmission could be determined.
Methods: Retrospective review of cases of genital gonorrhoea in pre-pubertal children managed according to an inter-agency assessment protocol from 2002 to 2008. This assessment protocol included extensive screening for potential sources of infection and early forensic interviewing of children old enough to be interviewed.
Results: 153 potential contacts of 10 prepubertal children with genital gonorrhoea diagnosed on the basis of positive cultures were investigated. Thirteen persons screened (8.5%) were positive for gonorrhoea, so 9/10 cases had at least one positive potential "contact". In four children, the mode of transmission was definitely sexual. In four other children, although the source of infection was unclear, there was no evidence of non-sexual transmission. One child probably acquired infection from another child. In one case, the parents argued strongly for non-sexual transmission, but the court regarded this as unproven.
Conclusion: Thorough review and contact tracing of pre-pubertal children with genital gonorrhoea found that sexual abuse could be determined as the mode of transmission for at least 40% of children. Although our sample size was limited, we found no case where non-sexual transmission could be determined.