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40 MMWR May 10, 2002 indistinguishable from N. gonorrhoeae on Gram-stained smear but can be differentiated in the microbiology laboratory. Recommended Regimen Ceftriaxone 25–50 mg/kg IV or IM in a single dose, not to exceed 125 mg. NOTE: Topical antibiotic therapy alone is inadequate and is unnecessary if systemic treatment is administered. Other Management Considerations Simultaneous infection with C. trachomatis should be considered when a patient does not improve after treatment. Both mother and infant should be tested for chlamydial infection at the same time that gonorrhea testing is conducted (see Ophthalmia Neonatorum Caused by C. trachomatis). Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely. Follow-Up Infants who have gonococcal ophthalmia should be hospitalized and evaluated for signs of disseminated infection (e.g., sepsis, arthritis, and meningitis). One dose of ceftriaxone is adequate therapy for gonococcal conjunctivitis. Management of Mothers and Their Sex Partners The mothers of infants who have gonococcal infection and the mothers’ sex partners should be evaluated and treated according to the recommendations for treating gonococcal infections in adults (see Gonococcal Infection in Adolescents and Adults). Disseminated Gonococcal Infection and Gonococcal Scalp Abscesses in Newborns Sepsis, arthritis, and meningitis (or any combination of these conditions) are rare complications of neonatal gonococcal infection. Localized gonococcal infection of the scalp can result from fetal monitoring through scalp electrodes. Detection of gonococcal infection in neonates who have sepsis, arthritis, meningitis, or scalp abscesses requires cultures of blood, CSF, and joint aspirate on chocolate agar. Specimens obtained from the conjunctiva, vagina, oropharynx, and rectum that are cultured on gonococcal selective medium are useful for identifying the primary site(s) of infection, especially if inflammation is present. Positive Gram-stained smears of exudate, CSF, or joint aspirate provide a presumptive basis for initiating treatment for N. gonorrhoeae. Diagnoses based on Gram-stained smears or presumptive identification of cultures should be confirmed with definitive tests on culture isolates. Recommended Regimen Ceftriaxone 25–50 mg/kg/day IV or IM in a single daily dose for 7 days, with a duration of 10–14 days, if meningitis is documented OR Cefotaxime 25 mg/kg IV or IM every 12 hours for 7 days, with a duration of 10–14 days, if meningitis is documented. Prophylactic Treatment for Infants Whose Mothers Have Gonococcal Infection Infants born to mothers who have untreated gonorrhea are at high risk for infection. Recommended Regimen in the Absence of Signs of Gonococcal Infection Ceftriaxone 25–50 mg/kg IV or IM, not to exceed 125 mg, in a single dose. Other Management Considerations Both mother and infant should be tested for chlamydial infection. Follow-Up Follow-up examination is not required. Management of Mothers and Their Sex Partners The mothers of infants who have gonococcal infection and the mothers’ sex partners should be evaluated and treated according to the recommendations for treatment of gonococcal infections in adults (see Gonococcal Infection). Gonococcal Infections Among Children Sexual abuse is the most frequent cause of gonococcal infection in pre-adolescent children (see Sexual Assault or Abuse of Children). Vaginitis is the most common manifestation of gonococcal infection in preadolescent girls. PID following vaginal infection is probably less common in children than among adults. Among sexually abused children, anorectal and pharyngeal infections with N. gonorrhoeae are common and frequently asymptomatic. Diagnostic Considerations Because of the legal implications of a diagnosis of N. gonorrhoeae infection in a child, o<strong>nl</strong>y standard culture procedures for the isolation of N. gonorrhoeae should be used for children. Nonculture gonococcal tests for gonococci (e.g., Gram-stained smear, DNA probes, EIA, and NAAT tests)
Vol. 51 / RR-6 Recommendations and Reports 41 should not be used alone; none of these tests have been approved by FDA for use with specimens obtained from the oropharynx, rectum, or genital tract of children. Specimens from the vagina, urethra, pharynx, or rectum should be streaked onto selective media for isolation of N. gonorrhoeae, and all presumptive isolates of N. gonorrhoeae should be identified definitively by at least two tests that involve different principles (e.g., biochemical, enzyme substrate, or serologic). Isolates should be preserved to enable additional or repeated testing. Recommended Regimens for Children Who Weigh >45 kg Treat with one of the regimens recommended for adults (see Gonococcal Infections). NOTE: Fluoroquinolones have not been recommended for persons aged
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Injuries Indicative of Abuse Class
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THE MEDICO-LEGAL TECHNICAL WORKING
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TABLE OF CONTENTS Introduction 7 Ou
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OUR GOALS It is the genuine hope of
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ANO-GENITAL EXAMINATION: EXTERNAL G
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ANO-GENITAL EXAMINATION: URETHRA AN
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EXTERNAL GENITALIA URETHRA AND PERI
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FORENSIC EVIDENCE AND LABORATORY RE
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Medical findings can then be catego
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APPENDICES � Appendix A: Abuse Do
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APPENDIX B: ADAMS CLASSIFICATION SY
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CLEAR EVIDENCE OF BLUNT FORCE OR PE
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APPENDIX C: SELECTED TERMS FROM THE
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Redundant Hymen: *Abundant hymenal
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