No, Ma’am, your 5 year old did not get gonorrhea from you

I’ll be traveling intermittently for another week, and will occasionally repeat an old column. This article originally appeared on my Open Salon blog in March 2009.

Sometimes an event is so ineffably sad that it almost defies comprehension. That was how I felt after a phone call on a bright Saturday morning in my last year of medical training.

As a chief-resident in obstetrics and gynecology, I was responsible for handling phone calls from patients who did not have a gynecologist of their own. On that Saturday morning, I took a call from a local women who was in her early 20’s. She sounded distraught, and at first, I couldn’t understand why she was calling.

“It’s about my 5 year old daughter,” she said. “I’m having a disagreement with her doctor and I want you to talk to him.”

“Okay,” I replied warily, “but I’m a gynecologist, so I’m not sure I could be very helpful.”

“No, no, you’re the right kind of doctor,” she insisted. “It’s a female problem.”

The mother proceeded to describe her daughter’s symptoms, vaginal itching and a greenish, malodorous discharge. The little girl’s pediatrician had examined her and gently taken a sample of discharge to look at under the microscope. When he returned to talk with the mother, he was very grim.

The microscopic evaluation of the discharge had reveal that the little girl was suffering from gonorrhea. It would not be difficult to treat; a simple shot of antibiotics should do the trick, but it could not end there. The pediatrician enquired if the mother knew where her daughter had contracted gonorrhea. It could only have come from sexual contact, which meant that someone had been sexually abusing the child.

The mother was aghast. She insisted that there was some mistake. There was no way her daughter could have been abused by anyone. The doctor disagreed.

The pediatrician informed her that, under the law, he had no choice but to file a “51A” The mother understood that a 51A was a legal document alleging child abuse. It would set in train an investigation by child protection officials, and might result in her child being removed from her custody. The mother protested, but the doctor was adamant.

Now she wanted to know if it were possible that her daughter’s vaginal infection was something other than gonorrhea. I explained that seeing the bacteria under the microscope was quite reliable, but, in any case, the doctor had taken a culture. That meant that the laboratory would also identify the bacteria. The culture results would be virtually 100% accurate, and, I cautioned her, would almost certainly confirm the diagnosis of gonorrhea.

“Well, even if she has gonorrhea,” inquired the mother, “couldn’t she have picked it up from a towel or a toilet seat?”

I explained that that was highly unlikely. The gonorrhea bacteria could not survive outside the body for very long. Neither towels nor toilet seats were likely to be the source of gonorrhea.

Suddenly, her voice brightened.

“I know, I know,” she said, “My little girl got it from me!”

“From you?” I didn’t understand.

“Yes, from me,” she replied. I had gonorrhea a few weeks ago. My daughter and me, we take baths together all the time. That’s how she must have gotten it.”

She was quite relieved. “I knew it,” she declared. “No one has been messing around with her. She caught it from me.”

I wasn’t so sure.

“You had gonorrhea?” I asked with trepidation. “How did you catch gonorrhea?”

I knew what was coming.

“Oh, I caught it from my boyfriend. He had it and he gave it to me. We both got antibiotic shots and now it’s gone.”

My heart sank.

“No, Ma’am, your daughter didn’t get gonorrhea from you.”

“She didn’t? Of course she did,” the mother protested. “Who else could have given it to her?”

I tried to be gentle, but how can you gently tell someone that her boyfriend has been sexually abusing her daughter?

The mother burst into tears. “That means the doctor is right, doesn’t it?”

“Yes, he is probably right.”

The mother continued sobbing. “I’m sorry,” she said. “I’m so sorry I bothered you. I just thought that there had to be some other way.”

I assured her that it had been no bother, though I had been shaken to the core.

“I’ve got to go now,” she wept. “I can’t talk anymore. I don’t understand. I just don’t understand. What am I going to do now?”