Genital ulcer disease in a four-year-old child: Diagnostic challenges in a resource-limited setting

Background/Objective: Genital Ulcer diseases (GUD) are ulcerative lesions around the genitals, with or without regional lymph node enlargement, and which may or may not be sexually transmitted. The presence of inguinal/femoral lymphadenopathy (buboes) increases the likelihood of a sexually transmitted infection, presumably Lymphogranuloma venereum (LGV) or Chancroid. These conditions are rare in nonsexually active persons, such as children. The Case: We report a rare case of GUD with inguinal and femoral lymphadenopathy in a 4 year old girl, who was often left in the care of an adolescent male relative. There was no disclosure of sexual abuse, however, physical findings revealed suppurative buboes, suggestive of a sexually transmitted infection (STI). Objective evidence of sexual penetration was absent, as physical examination revealed an intact hymen. Lack of trained manpower, and diagnostic tools are some of the limitations to confirmation of the aetiology of GUD in resource limited settings. Conclusion: This report is important on several fronts - it raises the possibility of childhood STI, but reveals the difficulty in confirming such a diagnosis in a resource deficient setting; it also brings into focus the probability of child sexual abuse (CSA) which is becoming more prevalent worldwide