Sexually transmitted infections in alleged sexual abuse of children and adolescents

Abstract

The prevalence of STI in children and young people referred for suspected sexual abuse is low but significant. Chlamydia and pelvic inflammatory disease were the most common infections. No STI was found in an asymptomatic pre-pubertal child.

Sexually Transmitted Diseases Among Adults Who Had Been Abused and Neglected as Children:A 30-Year Prospective Study

“…[1][2][3] Cross-sectional studies have described associations between self-reports of childhood abuse and a reported history [4][5][6][7][8][9][10][11][12][13][14][15] or biological markers 16,17 of sexually transmitted diseases (STDs) among adolescents or adults. Victims of child maltreatment may be at increased risk for STDs because of several factors: (1) direct exposure through child sexual abuse [18][19][20] ; (2) increased rates of risky sexual behavior among victims of sexual abuse 1,4-6, 13, 14,21-26 and nonsexual forms of child maltreatment 1,22,[27][28][29][30] ; (3) earlier initiation of sexual activity, 9,28,31,32 which is associated with increased risk for STDs 33,34 ; and (4) sexual activity with riskier partners. 8 However, not all studies have supported this relationship.…”

Medical and Legal Implications of Testing for Sexually Transmitted Infections in Children

“…The prevalence of HSV, mostly HSV-2, infection in these studies was low, Ͻ5% (20,26,38,44,47,63,65). In a recent multicenter study reported by Girardet et al, only 12 girls were found to have genital ulcers, 5 of whom were culture positive for HSV-2 (26).…”

“…Most published studies of STIs in sexually abused children that tested for T. vaginalis were limited to girls presenting with vaginal discharge (20,26,38,44,47,63,65). However, an identification of T. vaginalis appears to be strongly associated with sexual activity.…”

“…Although children can acquire syphilis through sexual abuse, the prevalence of syphilis in these children has been very low, Ͻ1% in most studies (20,26,38,44,47,65,84). The majority of these children were asymptomatic.…”

Epidemiology of Sexually Transmitted Infections in Suspected Child Victims of Sexual Assault

“…It has been suggested that the thinness of the vaginal epithelium in prepubertal girls and the likelihood of repeat abuse by the same perpetrator may increase the risk for HIV acquisition after unprotected intercourse, 4 and the same may be postulated for other infections; however, published prevalence studies of STIs in sexually abused children have reported rates of infection of Ͻ3%. [5][6][7][8] Citing the low yield of STI testing among asymptomatic prepubertal children, particularly in cases involving only fondling, the American Academy of Pediatrics Committee on Child Abuse and Neglect recommends that the decision to test be based on the type of sexual contact, the time since last sexual contact, whether there are signs/symptoms suggestive of an STI, whether a family member or a sibling has an STI, abuser risk factors for an STI, child or family concern, the prevalence of STIs in the community, and the presence of other examination findings. 9,10 Similarly, the Centers for Disease Control and Prevention (CDC) states that the decision to test should be made on an individual basis, taking into account the child's symptoms, the suspected offender's risk for STI infection, any STI infection in a member of the child's immediate environment, patient and parent requests for testing, and evidence of penetration or ejaculation on examination.…”