SHORT COMMUNICATION Prevalence and horizontal propagation of gonococcal infections among Nigerian children FE Emele and CE Anyiwo Medical Microbiology Department, Usman Danfodio University Teaching Hospital, Sokoto, Nigeria Emele FE, Anyiwo CE. Prevalence and horizontal propagation of gonococcal infections among Nigerian children. Acta Pædiatr 1998; 87: 1295–6. Stockholm. ISSN 0803-5253 The prevalence and mode of spread of gonococcal infections was studied among prepubertal children in Nigeria. Of 16 children with symptoms suggestive of sexually transmissible diseases (STD), 9 (56%) had gonorrhoea, while no causative organism was found in 7. The majority (7; 78%) of the gonococcal isolates produced penicillinase. Three of the cases were by child-to-child transmission, with female peers as the initiators. Prepubertal children should no longer be ignored as propagators of STD. Gonococcal infections, horizontal propagation, prepubertal children FE Emele, Department of Medical Microbiology, College of Medicine, Edo State University, PMB 14, Ekpoma, Nigeria Gonococcal infection is one of the most commonly encountered sexually transmitted diseases (STD) in the world, particularly in developing countries, where the level of medical awareness tends to be very low and preventive measures not readily enforced (1, 2). Children with sexually transmissible genital infections are usually assumed to be victims of child sexual abuse (3). Child sexual abuse is the involvement of developmentally imma- ture children and adolescents in sexual activities that they do not fully comprehend, to which they are unable to give informed consent or that violates social taboos of the family role (4). Little or no consideration is usually given to the possibility of child-to-child transmission of the dis- ease. For this reason, suspected cases of STD in children were followed up in Sokoto and Ekpoma, Nigeria, in order to gain knowledge of the pattern and mode of transmission of the disease among members of this group. Between 1990 and 1994 a total of 18 suspected cases of genitourinary infection in children, aged 10 y and below, was encountered in Sokoto and Ekpoma, Nigeria. Sixteen of these were encountered in Sokoto and two in Ekpoma. The series comprised 11 reported cases of suspected STD and 7 of their prepubertal sexual contacts. Their adult contacts were investigated but not included in this report. Nine of the index cases were seen at different clinics in Sokoto locality, from where they were referred to the Microbiology Laboratory of Usman Danfodio University Teaching Hospital, Sokoto, for sample collection and investigation. The two cases in Ekpoma were seen at the outpatient department of Irrua Specialist Teaching Hospital and were referred to the microbiology laboratory of the hospital for investigation. In the laboratory, genital discharges from the patients were analysed microbiologically (5) and cultural isolates identified by standard criteria (6). The index cases were thoroughly interviewed by the present authors, in the laboratory, with the assistance of community health nurses and in the absence of the parents. The patients were required to bring their sexual contacts for screening before results would be released to them. The sexual contacts were also interviewed and necessary microbiological investiga- tions carried out. b-Lactamase tests on the isolates were performed by iodometric techniques (7). Of the 18 children, 2 did not show any symptoms and no causative organisms were recovered. The other 16 showed clinical symptoms indicating STD; Neisseria gonorrhoea was isolated from 9 (56%) and no causative organisms were recovered from the other 7 children. Seven of nine gonococcal isolates were b-lactamase producing. Three of the gonorrhoea cases were males, who developed their symptoms after sexual intercourse with female peers who were among those subsequently identified as having gonor- rhoea. The three boys denied ever having had sexual inter- course with any adult. Four of the six girls acquired their gonococcal infections from sexually exploitative adult males. The source of infection in the remaining two female cases could not be traced. The majority (13; 81%) of the gonorrhoea cases occurred among those aged 5–10 y (Table 1). The result of this study shows that gonorrhoea in chil- dren could be horizontally transmitted, contrary to the commonly held view (3) that children with STD are always victims of adult sexual exploitation. In agreement with a previous report (6), more cases were found in girls than in boys. This may be because girls are more frequently exploited than boys. It was also noticed that girls more Acta Pædiatr 87: 1295–6. 1998  Scandinavian University Press 1998. ISSN 0803-5253