Inappropriate use of nonculture tests for the detection of Chlamydia trachomatis in suspected victims of child sexual abuse: A continuing problem

The introduction of nonculture tests for detection of Chlamydia trachomatis has revolutionized the management of chlamydial infections in sexually active adolescents and adults. However, these tests are insufficiently specific for use in genital and rectal sites in children; false-positive tests can be frequent. We report here 4 cases involving inappropriate use of nonculture tests in children in New York City during 1998. Two cases involved the use of enzyme immunoassays with vaginal specimens. In both cases the initial results were positive, however, cultures for C trachomatis performed later were negative. In the third case, the DNA probe test for C trachomatis was used. The fourth child was being evaluated for sexually transmitted diseases after rape. Although the pediatrician sent a rectal culture to a large commercial laboratory it was later determined that the laboratory was using an enzyme immunoassay for culture confirmation leading to a false-positive result. At the least the use of these inappropriate tests resulted in unnecessary retesting and at the worst, unnecessary hospitalization, erroneous reports of sexual abuse and possibly unjustified prosecution and incarceration. Because of the social and legal implications it is important that practitioners be aware of these recommendations and require that commercial laboratories adhere to approved C trachomatis culture methods.