Use of APTIMA Combo 2: the experience of a child advocacy center.

The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for chlamydia and gonorrhea in sexually abused girls. No studies describe performance of APTIMA Combo 2 Assay with second target confirmation on the same testing platform. This nucleic acid amplification testing is evaluated within a large child advocacy center. Girls 3 to 18 years, 35% of whom reported consensual sexual activity, were prospectively tested by APTIMA Combo 2 on urine/vaginal swabs and by vaginal culture. A case of infection was defined as positive culture or positive urine or vaginal swab nucleic acid amplification testing with second target confirmation. Sensitivity of APTIMA Combo 2 on urine was found to be superior to vaginal culture and comparable to APTIMA Combo 2 on vaginal swabs for both infections. APTIMA Combo 2 on urine is less invasive, and its use may be preferred in this traumatized population.

Precepting genital exams: challenges in implementing a complex educational intervention in the continuity clinic.

BACKGROUND: The female genital exam is often omitted from the routine physical. This limits familiarity with normal findings and represents a missed opportunity to evaluate girls for urogenital abnormalities. Continuity clinic offers an opportunity to develop and test a teaching intervention to address this problem. OBJECTIVE: To describe the effect of precepted genital exams on resident confidence and comfort with the exam as well as knowledge and documentation of genital anatomy. METHODS: A controlled trial was conducted in 10 continuity clinics at Children's Hospital, Columbus, Ohio. Residents in 5 clinics reviewed genital anatomy, exam positions, and documentation examples. They were asked to complete 6 precepted exams of girls aged 1-6 years during well-child care over a 6-month period. Residents were given pre- and posttests assessing knowledge of, confidence, and comfort with the genital exam. Pre- and poststudy genital exam documentation was reviewed. RESULTS: Ninety-seven percent of the intervention group, compared to 73% of the control group, answered 4 or 5 on a 5-point scale of confidence with regard to recognizing a normal exam (5 = highest) following the intervention (P = .01). Ninety-four percent of the intervention group and 64% of the control group answered 4 or 5 with regard to how comfortable they were performing genital exams (P = .01). Knowledge scores and documentation of genital anatomy did not differ between groups. Thirty-two percent of residents had the full intervention. CONCLUSIONS: Resident confidence and comfort increase with precepting. Precepting did not improve knowledge or documentation of genital anatomy. We advocate use of this preliminary data to design and test future educational interventions.