Prevalence of Gardnerella vaginalis in prepubertal males.

OBJECTIVES: To determine the rate of occurrence of Gardnerella vaginalis in the genital tract and rectum of the asymptomatic prepubertal boy and to examine the effect of circumcision on the rate of recovery. DESIGN: A prospective survey design was used. Cultures for G vaginalis were obtained from the urethral meatus, surrounding glans, and rectum of prepubertal boys. Boys who had a history of sexual abuse, current urogenital symptoms, or who had taken antibiotics in the preceding 2 weeks were excluded from this study. SETTING: The study was conducted in ambulatory clinical settings at a children's hospital within a major medical center that serves as a statewide referral center. PARTICIPANTS: A group of 99 circumcised and uncircumcised prepubertal boys participated in the study. The participants ranged in age from 1 month to 7 years 4 months. MAIN OUTCOME MEASURE: Results of cultures for G vaginalis. RESULTS: No cultures were positive for G vaginalis from the urethra, glans, or rectum in any of the participants in this study. CONCLUSIONS: The findings of this study provide preliminary evidence that G vaginalis is not an organism that commonly colonizes the urogenital or gastrointestinal tract in asymptomatic prepubertal boys. Based on these findings, it does not seem prudent to apply the concept of asymptomatic colonization to prepubertal boys unless further studies refute these findings.

Pregnant adolescents in the emergency department: diagnosed and not diagnosed.

A study was conducted to compare the presenting complaints and historical information of adolescents diagnosed as pregnant (DP) in the emergency department (ED) with adolescents seen in the ED who were pregnant and not diagnosed (MP). Medical records for the period 1980-94 were retrospectively analyzed to identify patients 16 years of age or younger who were diagnosed as pregnant in the ED or who had a live birth and had an ED visit during pregnancy. This analysis was done in a university-affiliated tertiary referral hospital with approximately 65,000 ED visits and 3,500 deliveries each year. The DP patients had complaints referable to the abdomen or genitourinary system more commonly than the MP patients (91% v 22%). Less than 10% of the DP patients mentioned the possibility of pregnancy at initial triage, 10.5% denied being sexually active, and 5% had a pelvic examination and sexually transmitted disease screening; 68% of MP patients did not have sexual or menstrual history documented, and 5% had a pelvic examination. The diagnosis of pregnancy can be a challenge in patients who present to a busy ED with complaints that are not necessarily suggestive of pregnancy. Historical information regarding menses and sexual activity is either not obtained or is incomplete or inaccurate. We recommend a low threshold for the consideration of pregnancy in adolescents irrespective of the presenting complaint.

PIP: A retrospective study was performed at a tertiary care hospital in Mississippi to compare the emergency room (ER) presenting complaints during 1980-1994 of the 171 pregnant adolescents 16 years old and younger whose pregnancies were diagnosed with the 100 whose pregnancies were not diagnosed. Data were collected from the medical records of those diagnosed as pregnant and from the 2945 records available of the 4125 patients under 16 who delivered babies at the hospital during the same period. It was found that 100/2945 were seen in the ER while pregnant but the pregnancy was not diagnosed. It was found that 91% of the pregnancy diagnosed patients versus 22% of the missed diagnosis patients had complaints relating to the abdomen or genitourinary system. Less than 10% of the diagnosed patients indicated the possibility of pregnancy at the initial examination, and 10.5% denied being sexually active. No sexual or menstrual history was documented for 68% of the missed diagnosis patients, and 5% of each group had pelvic examinations. No significant differences were found for patient age or demographics, gestation at ER visit, or gestation at delivery. In 30 cases of missed diagnoses (all with gestation at 8 weeks or more), 23 presented with abdominal, genitourinary, or mammary complaints, and 7 presented with drug overdoses. In 22 patients, diagnosis was missed even though the pregnancy was at 22 weeks gestation or more. One extraordinary case involved a 14-year-old who was admitted for treatment of a gunshot to the head. Her pregnancy was not diagnosed until her second follow-up visit after a lengthy hospital stay (gestation was 30 weeks at ER presentation). Because many treatments are modified by pregnancy, it is recommended that pregnancy be assumed in all females of child-bearing age presenting to the ER with consideration given to degree of sexual maturity.

Henoch-Schönlein purpura: four cases and a review.

Henoch-Schönlein Purpura (HSP) is a common, usually self-limited, vasculitis affecting children and young adults. Manifested by a characteristic rash, the course of HSP is typically a benign one, but may be accompanied by varying degrees of abdominal pain, arthritis or arthralgia, gastrointestinal bleeding, and nephritis. The various manifestations of HSP may present at any stage during the illness and mimic other disease processes, some of which may be life threatening. Thus, the emergency physician must consider the diagnosis of HSP in order to detect complications and avoid needless intervention in what usually is an otherwise benign process. We present four cases and a brief review of the literature to highlight HSP in the differential diagnosis of patients who present with any of the typical clinical signs and symptoms.