Sexually Transmitted Disease in Children

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   Neonates, pre-pubertal and pubertal children are also at risk of contracting STIs. The modes of transmission in these children are mostly through maternal infections, sexual abuse or exploitation and voluntary sexual activity in older children. The STls in this age group include neonatal conjunctivitis (ophthalmia neonatorum), and other STI-related
syndromes similar to that in adults.
   Some of these STls (e.g., gonorrhea, syphilis, and chlamydia), if acquired after the neonatal period, are indicative of sexual contact. For other STls, (e.g. HPV infections and vaginitis), the association with sexual contact is not clear.

STI related Neonatal Conjunctivitis

See Section:

Neonatal Conjunctivitis (Opthalmia Neonatorum)

STI related Urethral Discharge Syndrome in Children

For Gonorrhea

Children <12 years (or child < 45 kg)

  • Ceftriaxone, IM, 125 mg stat.

Children > 12 years (or child > 45 kg)

  • Cefixime, oral, 400 mg stat. 

Or

  • Ceftriaxone, IM,250 mg stat. 

And

 For Chlamydia 

Children < 12 years 

  • Erythromycin, oral, 12.5 mg/kg  6 hourly for 14 days

Children > 12 years

  • Azithromycin, oral, 1g stat.

Or

  • Doxycycline, oral, 100 mg 12 hourly for 7 days

Or

  • Erythromycin, oral, 500 mg 6 hourly for 7 days

STI-related Vaginal Discharge Syndromes in Children

Note: Examination should be carried out without a speculum. Intravaginal treatment is not recommended for younger girls. Oral treatment may be more appropriate. 

Non-pharmacological treatment

  • Ensure good genital hygiene 
  • Encourage use of loose underwear
  • Dry underwear in the sun or iron with hot plate
  • Ensure good peri-anal hygiene
  • Avoid douching with herbal or chemical preparations
  • Avoid medicated soaps

Pharmacological treatment

A. For Vaginitis (Trichomoniasis and Bacterial vaginosis)

Children < 12 years (or < 45 kg)

  • Metronidazole, oral, 7.5 mg/kg 12 hourly for 7days

Children > 12years (or > 45 kg)

  • Metronidazole, oral, 400 mg 12 hourly for 7days

Or

  • Metronidazole, oral, 2 g stat.

And

B. For Candidiasis

  • Clotrimazole  2%  cream,  topical  (vaginal),  apply  8-12  hourly  for  7 days 

Or

  • Fluconazole, oral, 3-6 mg/kg stat

Note: Intravaginal treatment is not recommended for younger girls. Oral treatment may be more appropriate.  

And

C. For Cervicitis

For Gonorrhea

Children <12 years (or < 45 kg)

  • Ceftriaxone, IM, 125 mg stat.

Children >12 years (or > 45 kg)

  • Cefixime, oral, 400 mg stat.

Or

  • Ceftriaxone, IM, 250 mg stat.

And

For Chlamydia

Children <12 years

  • Erythromycin, oral, 12.5 mg/kg 6 hourly for 14 days

Children >12years

  • Azithromycin, oral, 1g stat.

Or

  • Doxycycline, oral, 100 mg 12 hourly for 7 days 

Or

  • Erythromycin, oral, 500 mg 6 hourly for 7 days

STI-related Lower Abdominal Pain or Pelvic Inflammatory Disease Syndrome in Children

Children < 12 years (or < 45 kg)

  • Ceftriaxone, IM, 125 mg stat.

And

  • Erythromycin, oral, 12.5 mg/kg 6 hourly for 14 days

And

  • Metronidazole, oral, 7.5 mg/kg 12 hourly for 14 days

Children > 12 years

  • Ceftriaxone, IM, 250 mg stat. 

And

  • Doxycycline, oral, 100 mg 12 hourly for 14 days 

And

  • Metronidazole, oral, 400 mg 12 hourly for 14 days

STI-related Genital Ulcer Syndrome in Children

For Syphilis

  • Benzyl penicillin, IV,

Children 

>12 years; 50,000 units/kg 4-6 hourly for 10 days

<12 years; 50,000 units/kg 4-6 hourly for 10 days

Or

  • Procaine penicillin, IM (deep), 

Children

>12 years; 1.2MU daily for 10 days

<12 years; 50,000 IU/kg  daily for 10 days (max.  daily  dose  750,000 units)

Or

  • Benzathine Penicillin, IM,

> 12 years; 1.2 MU into each buttock during one clinic visit (total 2.4 MU)

For persons allergic to penicillin:

  • Doxycycline, oral, 100 mg 12 hourly for 14 days

Or

  • Tetracycline, oral, 500 mg 6 hourly for 14 days

And

For Chancroid

Children  > 12 years

  • Cefixime, oral, 400 mg stat.

Or

  • Azithromycin, oral, 1 g stat.

Or

  • Doxycycline, oral, 100 mg 12 hourly for 7 days

Or

  • Erythromycin, oral, 500 mg 6 hourly for 7 days

Children < 12 years (or < 45 kg)

  • Ceftriaxone, IM, 250 mg stat.

Or

  • Erythromycin, oral, 12.5 mg/kg 6 hourly for 7 days

And

For Genital Herpes Simplex

  • Aciclovir, oral, 

Children

> 2 years; 200 mg 4-6 hourly for 5 days

1 month-2 years; 100 mg 4-6 hourly for 5 days

For Infants with Known or Suspected Neonatal Herpes 

  • Aciclovir, IV, 

Children  < 1 month 

20 mg/kg every 8 hours for 14 days (for disease limited to the skin  and mucous membranes) 

Or

20 mg/kg every 8 hours for 21 days (for disseminated and CNS disease)

STI-related Ano-Rectal Related Syndromes in Children

Ano-rectal Discharge

For Gonorrhea

Children >12 years (or  > 45 kg)

  • Cefixime, oral, 400 mg stat.

Or

  • Ceftriaxone, IM, 250 mg stat.

Children < 12 years (or  < 45 kg)

  • Ceftriaxone, IM, 125 mg stat.

And

For Chlamydia

Children >12 years

  • Azithromycin, oral, 1 g stat.

Or

  • Doxycycline, oral, 100 mg 12 hourly for 7 days

Or

  • Erythromycin, oral, 500 mg 6 hourly for 7 day

Children < 12 years

  • Erythromycin, oral, 12.5 mg/kg 6 hourly for 14 days

Anorectal ulcers / vesicles 

  • For Syphilis  (See sections above under ‘Genital Ulcer Syndrome in Children’ for treatment of Syphilis)
  • For Chancroid  (See sections above under ‘Genital Ulcer Syndrome in Children’ for treatment of Chancroid)
  • For Genital Herpes  (See sections above under ‘Genital Ulcer Syndrome in Children’ for treatment of Genital Herpes)

Genital Warts in Children 

(See section on treatment of ‘Genital Warts’ in adults. Podophyllotoxin and Imiquimod are not used in children)

Scabies 

(See section on ‘Pruritus’)

Pubic Lice

  • Malathion liquid 0.5% in aqueous base 
  • Apply over whole body and allow to dry naturally. Wash off after 12  hours or overnight. Repeat after 1 week

Referral Criteria 

If the symptoms or lesions do not improve after treatment refer to a health facility with microbiology support for appropriate treatment and exclusion of other causes to exclude other causes.