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• W2495684011 abstract "To the Editor:We read with interest the brief communications describing syphilis brephotrophica (J Am Acad Dermatol 1998;38:638-9) 1Hofmann B Schuppe H-C Ruzicka T Kuhn A Lehmann P Acquired syphilis II in early childhood: reappearance of syphilis brephotrophica.J Am Acad Dermatol. 1998; 38: 638-639Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar and have several comments. The report described a case of syphilis in a 2-year-old boy, which was assumed to have been acquired via nonsexual transmission. The authors state, “Nonsexual transmission of syphilis was frequent during the preantibiotic era at the beginning of this century” (p. 639). Supporting references consist of 4 citations written between 1930 and 1947. Mandated reporting laws for child abuse were not uniformly legislated in the United States until 1966. Before 1978, sexual abuse was a hidden problem unrecognized even by the medical community. 2Kempe CH Sexual abuse: another hidden pediatric problem.Pediatrics. 1978; 62: 382-389PubMed Google Scholar Today, an estimated 1 in 4 girls and 1 in 7 boys are victims of child sexual abuse.3Finkelhor D Hotaling G Lewis IA et al.Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors.Child Abuse Negl. 1990; 14: 19-28Crossref PubMed Scopus (1379) Google Scholar The majority of abused children do not exhibit physical signs.4Frasier LD Barchman V Alexander RC Physical and behavioral signs of sexual abuse in infants and toddlers.Inf Young Child. 1992; 5: 1-13Crossref Scopus (4) Google Scholar, 5Bays J Chadwick D Medical diagnosis of the sexually abused child.Child Abuse Negl. 1993; 17: 91-110Crossref PubMed Scopus (136) Google Scholar A child’s disclosure is the most reliable means of diagnosis.6Myers J The role of the physician in preserving verbal evidence of child abuse.J Pediatr. 1986; 109: 409Abstract Full Text PDF PubMed Scopus (19) Google Scholar Gonorrhea and syphilis are the only sexually transmitted diseases considered to be absolute indicators of sexual abuse.7American Academy of Pediatrics Committee on Child Abuse and Neglect Guidelines for evaluation of sexual abuse in children.Pediatrics. 1991; 87: 254-260PubMed Google Scholar The antiquated references cited merely reflect the naivete of that era. Although there is convincing evidence in this case that the mode of transmission was innocent, the authors failed to detail the most important aspect of the evaluation: the methods they used to rule out sexual abuse. This case reminds us of the importance of a thorough work-up in establishing an accurate diagnosis of sexual abuse. Childhood syphilis is believed to be a pathognomonic marker in 1998. This case may well be an exception, in contrast to childhood condyloma, in which associated sexual abuse may be less common. 8Siegfried EC Frasier LD Anogenital warts in children.Adv Dermatol. 1997; 12: 141-167PubMed Google Scholar, 9Cohen B Honig P Androphy E Anogenital warts in children.Arch Dermatol. 1990; 126: 1575-1580Crossref PubMed Scopus (97) Google Scholar Misdiagnosis of both abuse and nonabuse can be devastating to patient and family. To the Editor:We read with interest the brief communications describing syphilis brephotrophica (J Am Acad Dermatol 1998;38:638-9) 1Hofmann B Schuppe H-C Ruzicka T Kuhn A Lehmann P Acquired syphilis II in early childhood: reappearance of syphilis brephotrophica.J Am Acad Dermatol. 1998; 38: 638-639Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar and have several comments. The report described a case of syphilis in a 2-year-old boy, which was assumed to have been acquired via nonsexual transmission. The authors state, “Nonsexual transmission of syphilis was frequent during the preantibiotic era at the beginning of this century” (p. 639). Supporting references consist of 4 citations written between 1930 and 1947. Mandated reporting laws for child abuse were not uniformly legislated in the United States until 1966. Before 1978, sexual abuse was a hidden problem unrecognized even by the medical community. 2Kempe CH Sexual abuse: another hidden pediatric problem.Pediatrics. 1978; 62: 382-389PubMed Google Scholar Today, an estimated 1 in 4 girls and 1 in 7 boys are victims of child sexual abuse.3Finkelhor D Hotaling G Lewis IA et al.Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors.Child Abuse Negl. 1990; 14: 19-28Crossref PubMed Scopus (1379) Google Scholar The majority of abused children do not exhibit physical signs.4Frasier LD Barchman V Alexander RC Physical and behavioral signs of sexual abuse in infants and toddlers.Inf Young Child. 1992; 5: 1-13Crossref Scopus (4) Google Scholar, 5Bays J Chadwick D Medical diagnosis of the sexually abused child.Child Abuse Negl. 1993; 17: 91-110Crossref PubMed Scopus (136) Google Scholar A child’s disclosure is the most reliable means of diagnosis.6Myers J The role of the physician in preserving verbal evidence of child abuse.J Pediatr. 1986; 109: 409Abstract Full Text PDF PubMed Scopus (19) Google Scholar Gonorrhea and syphilis are the only sexually transmitted diseases considered to be absolute indicators of sexual abuse.7American Academy of Pediatrics Committee on Child Abuse and Neglect Guidelines for evaluation of sexual abuse in children.Pediatrics. 1991; 87: 254-260PubMed Google Scholar The antiquated references cited merely reflect the naivete of that era. Although there is convincing evidence in this case that the mode of transmission was innocent, the authors failed to detail the most important aspect of the evaluation: the methods they used to rule out sexual abuse. This case reminds us of the importance of a thorough work-up in establishing an accurate diagnosis of sexual abuse. Childhood syphilis is believed to be a pathognomonic marker in 1998. This case may well be an exception, in contrast to childhood condyloma, in which associated sexual abuse may be less common. 8Siegfried EC Frasier LD Anogenital warts in children.Adv Dermatol. 1997; 12: 141-167PubMed Google Scholar, 9Cohen B Honig P Androphy E Anogenital warts in children.Arch Dermatol. 1990; 126: 1575-1580Crossref PubMed Scopus (97) Google Scholar Misdiagnosis of both abuse and nonabuse can be devastating to patient and family. We read with interest the brief communications describing syphilis brephotrophica (J Am Acad Dermatol 1998;38:638-9) 1Hofmann B Schuppe H-C Ruzicka T Kuhn A Lehmann P Acquired syphilis II in early childhood: reappearance of syphilis brephotrophica.J Am Acad Dermatol. 1998; 38: 638-639Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar and have several comments. The report described a case of syphilis in a 2-year-old boy, which was assumed to have been acquired via nonsexual transmission. The authors state, “Nonsexual transmission of syphilis was frequent during the preantibiotic era at the beginning of this century” (p. 639). Supporting references consist of 4 citations written between 1930 and 1947. Mandated reporting laws for child abuse were not uniformly legislated in the United States until 1966. Before 1978, sexual abuse was a hidden problem unrecognized even by the medical community. 2Kempe CH Sexual abuse: another hidden pediatric problem.Pediatrics. 1978; 62: 382-389PubMed Google Scholar Today, an estimated 1 in 4 girls and 1 in 7 boys are victims of child sexual abuse.3Finkelhor D Hotaling G Lewis IA et al.Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors.Child Abuse Negl. 1990; 14: 19-28Crossref PubMed Scopus (1379) Google Scholar The majority of abused children do not exhibit physical signs.4Frasier LD Barchman V Alexander RC Physical and behavioral signs of sexual abuse in infants and toddlers.Inf Young Child. 1992; 5: 1-13Crossref Scopus (4) Google Scholar, 5Bays J Chadwick D Medical diagnosis of the sexually abused child.Child Abuse Negl. 1993; 17: 91-110Crossref PubMed Scopus (136) Google Scholar A child’s disclosure is the most reliable means of diagnosis.6Myers J The role of the physician in preserving verbal evidence of child abuse.J Pediatr. 1986; 109: 409Abstract Full Text PDF PubMed Scopus (19) Google Scholar Gonorrhea and syphilis are the only sexually transmitted diseases considered to be absolute indicators of sexual abuse.7American Academy of Pediatrics Committee on Child Abuse and Neglect Guidelines for evaluation of sexual abuse in children.Pediatrics. 1991; 87: 254-260PubMed Google Scholar The antiquated references cited merely reflect the naivete of that era. Although there is convincing evidence in this case that the mode of transmission was innocent, the authors failed to detail the most important aspect of the evaluation: the methods they used to rule out sexual abuse. This case reminds us of the importance of a thorough work-up in establishing an accurate diagnosis of sexual abuse. Childhood syphilis is believed to be a pathognomonic marker in 1998. This case may well be an exception, in contrast to childhood condyloma, in which associated sexual abuse may be less common. 8Siegfried EC Frasier LD Anogenital warts in children.Adv Dermatol. 1997; 12: 141-167PubMed Google Scholar, 9Cohen B Honig P Androphy E Anogenital warts in children.Arch Dermatol. 1990; 126: 1575-1580Crossref PubMed Scopus (97) Google Scholar Misdiagnosis of both abuse and nonabuse can be devastating to patient and family." @default.
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