Vaginal discharge due to undiagnosed bilateral duplicated collecting system with ectopic ureters in a three-year-old female: an initial high index of suspicion for sexual abuse.

In prepubertal girls with vaginal discharge, consideration of the etiology must be given to respiratory pathogens (Streptococcus pyogenes, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, and Neisseria meningitidis), enteric pathogens (Escherichia coli, Shigella, and Yersinia), poor hygiene, foreign body, nonabsorbent undergarments, irritants, vulvar skin disease, anatomic abnormalities (double vagina with fistula, pelvic abscess, and ectopic ureter), and sexual abuse. Prepubertal girls, outside the newborn period, with suspected gonococcal infection should be strongly considered to be victims of sexual abuse, once congenital and other newborn acquired forms of gonorrhea are excluded. We present a case of a three-year-old female with vaginal discharge and fever with a clouded social history, disproportionate distress on physical exam, and initial laboratory gram stain suggestive of gonococcus.