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An 11-year-old Austrian girl was reportedly infected with gonorrhea after bathing in a popular thermal pool while on vacation in Italy. 

The girl was diagnosed with Neisseria gonorrhoeae following a dip in the hot spring off the island of Pantelleria’s crater lake Specchio di Venere, also known as the “Mirror of Venus.” 

The girl’s case was reported in a study earlier this fall in the Journal of Medical Case Reports.

Two days after her family’s visit to the pool, amoxicillin mouth sores researchers from New Zealand’s University of Auckland and Austria’s University of Salzburg said the girl developed vulvovaginitis.

Vulvovaginitis is an inflammation or irritation of the vagina and vulva, and the condition was partially relieved with over-the-counter antifungal cream.

Vaginal swabs cultured positive for the bacterial pathogen responsible for gonorrhea, but the child’s family members tested negative. 

The report showed that the family had split up, with her and her father wading into one pool and her mom and younger sister in another. 

Because the girl adamantly denied any sexual contact and no opportunities for sexual exposure could be identified, it was concluded that she must have acquired the infection from pool water contaminated by gonococcus after a two-day incubation period. 

Eventually, the infection was successfully treated using ceftriaxone and azithromycin, with no adverse effects.

The girl’s pediatrician recommended whey baths for a period of two weeks to help restore her vaginal flora, and vaginal symptoms settled within a few days. A repeat swab four weeks later was negative.

The experts believe that the temperature of the slightly acidic water served as a potential source of the infection.

The study’s authors said that there needs to be public understanding regarding the risk of exposure to pathogens by bathing in heavily frequented shallow thermal pools.

They suggested adding a sign, a shower and antibacterial soap near the hot springs.

“There are historical case reports in the literature of gonococcal epidemics in children’s hospitals being traced to common baths. It is imperative that all cases of gonococcal infection in children are fully investigated, including examining all other relevant family members, to determine whether sexual assault has occurred. This is not a diagnosis to be missed,” they wrote. “However, both sexual and nonsexual transmission are possible. A presumption that a gonococcal infection is diagnostic of sexual abuse can be dire, with children wrongfully removed from their parents’ care and their caregivers facing false charges of sexual crimes.”

“Our case serves to illustrate that the very uncommon diagnosis of gonorrhea in a child may be the result of nonsexual transmission of the infection, and that contaminated hot pools are a very rare source of infection that should be considered,” the authors said. 

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