Margaret McNeese

Day-night pattern in accidental exposures to blood-borne pathogens among medical students and residents

The purpose of this study was to determine whether the occurrence of accidental blood-borne pathogen exposure incidents in medical students and residents in training varies during the 24h. A retrospective review of reported exposures was conducted in a large urban teaching institution—the University of Texas Health Science Center in Houston—between November 1993 and July 1998. Professional level (year of student or level of resident), time of exposure, means/route of exposure (needle stick, laceration, or splash), and type of medical service were recorded. Analysis of the clock time of the 745 reported blood-borne pathogen exposures showed they occurred more frequently during the day than night. Over the nearly 5-year span, 531 incidents took place between 06:00 and 17:59 in comparison to only 214 between 18:00 and 05:59. To account for the day-night difference in medical student and resident hospital staffing, the data were reexpressed as exposure rates, that is, in terms of the number of events per hour per 1000 medical students and residents. Based on the total number of reported exposures over the almost 5-year span of data collection, the average rate was 40 accidents per hour per 1000 doctors in training during the 12h daytime span (6:00–17:59). It was 50% greater at night (18:00–05:59), with 60 incidents per hour per 1000 doctors in training. The day-night difference in rate of exposures was statistically significant (p<.04). The relative risk ratio for residents and students when working during the day shift compared to working the night shift was 0.67. This means that doctors in training are at a 1.50 higher risk of sustaining a blood-borne pathogen exposure when working nights than when working days. (Chronobiology International, 17(1), 61–70, 2000)

Comparison of the urine-based ligase chain reaction test to culture for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in pediatric sexual abuse victims.

BACKGROUND The urine-based ligase chain reaction (LCR) assay for Chlamydia trachomatis and Neisseria gonorrhoeae is an attractive alternative to culture because of the relative ease with which specimens may be collected, transported and processed. In addition LCR offers superior sensitivity while maintaining high specificity when compared with culture in various studies of adolescents and adults. A study comparing LCR to culture has not been published concerning children. METHODS We conducted a prospective, comparison trial of the urine-based LCR test for Chlamydia trachomatis and Neisseria gonorrhoeae as compared with culture among children at a specialized referral center for evaluation for alleged sexual assault. Of the 1,010 children presenting to the center during the study period, 164 met the study requirements for risk of a sexually transmissible disease and collection of both culture and urine LCR specimens. RESULTS Eight specimens tested positive by both methods for C. trachomatis. Another 10 specimens tested positive for C. trachomatis by LCR but were negative by culture. No patient with a negative LCR for C. trachomatis had a positive culture. For N. gonorrhoeae 2 specimens tested positive by both methods, and 3 specimens tested positive by LCR but negative by culture. No patient with a negative LCR for N. gonorrhoeae had a positive culture. CONCLUSIONS The low prevalence of disease in the study population precluded statistical analysis. LCR may prove to be as specific and more sensitive than culture for the detection of C. trachomatis and N. gonorrhoeae in children. Further studies are needed.

Evaluation of sexual abuse in the pediatric patient.

Evaluating a patient for suspected child sexual abuse can be daunting for many pediatric primary care practitioners. The consequences of misdiagnosis can be devastating. Knowledge of common clinical presentations, both physical signs and symptoms and behavioral changes, is paramount. Sexual abuse allegations must be reported and investigated by child protection agencies or law enforcement. Practitioners must be aware of when and how to report suspected child sexual abuse, in addition to having a basic understanding of the medical examination and findings. With a caring, knowledgeable, and sensitive approach to allegations of sexual abuse, the practitioner can assist the child and his or her family through this very difficult process.

Screening and treatment of sexually transmitted diseases. Part 1: Chlamydia, gonorrhea, and bacterial vaginosis.

Despite increased public awareness sexually transmitted diseases (STDs) remain a major cause of morbidity and an important public health issue for adolescents. Each year more than 2.5 million teenagers are diagnosed with STDs and many more are infected subclinically. Whereas effective treatment regimens exist for many STDs others can only be treated symptomatically and patients must be counseled regarding transmission. The scope of this guideline includes evaluation of sexually active adolescents and treatment of common STDs other than human immunodeficiency virus (HIV) and syphilis. Sexually active adolescents may benefit from scheduled medical visits every 6 to 12 months (or more frequently if they are at higher risk or symptomatic). Serologic testing for syphilis and HIV is offered and is recommended for high-risk adolescents. If not previously administered the hepatitis B immunization series should be started and in male homosexual patients administering the hepatitis A vaccine should also be considered. Counseling about STDs and pregnancy as well as abstinence should take place at every visit. (excerpt)

Practice guidelines: Screening and treatment of sexually transmitted diseases part 2: Trichomonas, human papillomavirus infection, and genital herpes simplex virus

This article is Part 2 of a practice guideline on the screening and treatment of sexually transmitted diseases (Part 1 appeared in the January/February 2000 issue of the Journal). GENERAL SEXUAL HISTORY: Number of partners; Infected or symptomatic partners; Sexual orientation and characteristics of partners (ie age homosexuality/ bisexuality); Type of sexual activity (anal oral vaginal intercourse); Condom use; and Alcohol and drug use. (excerpt)