Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children

Abstract

Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.

Gaps in Sexual Assault Health Care Among Homeless Young Adults

“…18 Use of HIV nonoccupational postexposure prophylaxis for sexual assault patients is recommended in the guidelines based on exposure timing and characteristics. 19 However, little is known about post−sexual assault healthcare utilization among youth experiencing homelessness.…”

Introductory Chapter: The Latest Knowledge

“…But it should always be kept in mind that there may be sexual abuse [44]. Victims of sexual abuse were reported as 1.8 per 1000 children in 2006 [45].…”

“…Therefore, HPV vaccination for CSA survivors aged 9-26 years for females and aged 9-21 years for males is recommended in accordance with ACIP [45].…”

Cuidado integral a vítimas de violência sexual em serviço de referência de São Paulo: caracterização de usuários atendidos em até 72 horas após a agressão, adesão à profilaxia pós-exposição da infecção por HIV e retenção no cuidado

“…No entanto, apesar de eficaz e custo-efetiva, a consolidação a recomendação de nPEP após VS na prática clínica somente ocorreu a partir da virada do milênio (CDC, 1998;Krug et al, 2002;CDC, 2002;Roland, 2007;Rey et al, 2000;Chacko et al, 2012;Brasil, 2012;Seña et al, 2015). (Brasil, 1999(Brasil, , 2005b(Brasil, e 2012.…”

“…Particularmente em crianças, há maior dificuldade de se comprovar a VS do ponto de vista forense e nessas vítimas descrevem-se lesões genitais após a agressão em até 35% dos casos (Drezett et al, 2001;Danielson e Holmes 2004;White e McLean, 2006;Drezett et al, 2011;Hariton, 2012;Hornor et al, 2012;Elgendy e Hassan, 2013;Sudupe Moreno, 2013;Walker, 2015;Essabar et al, 2015). (Krug et al, 2002;Smith et al, 2005;Du Mont et al, 2011;Linden, 2011;Brasil, 2012, Chacko et al, 2012Draughon et al (2014);CDC, 2016;Seña et al, 2015, WHO, 2017. Uma vez adotada, torna-se muito importante avaliar a adesão a essa intervenção, de modo a garantir sua efetividade em saúde pública.…”