Pediatric emergency medicine trisk 4238 4238
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many other drugs of abuse are not included in standard drug-screening
panels.
Pregnancy Testing
Pregnancy testing should be performed on all pubertal females as well as all
females >11 years of age.
STI Testing
With rare exception, the identification of most sexually transmitted
infections (STIs) in children beyond the neonatal period suggests sexual
abuse. Postnatally acquired gonorrhea (GC), chlamydia (CT), syphilis, and
non–transfusion-acquired HIV are usually diagnostic of sexual abuse. Sexual
abuse should also be considered when genital herpes is diagnosed. Although
genital warts are found in sexually abused children, they can also be present
in children in whom there is no suspicion of abuse due to the high
prevalence of human papillomavirus in the population. The possibility of
sexual abuse must be investigated thoroughly if no conclusive explanation
for nonsexual transmission of an STI can be identified. The recommended
action by the American Academy of Pediatrics (AAP) regarding the
reporting of suspected child sexual abuse varies by the specific organism and
is outlined in Table 127.4 .
The decision to evaluate STIs is made on an individual basis. Most
experts recommend that pubertal victims of sexual assault undergo STI
testing as the prevalence of pre-existing asymptomatic infection in this group
is high. Therefore, although the identification of an STI may represent an
infection consensually acquired prior to the assault, laws in all 50 states
strictly limit the evidentiary use of a survivor’s previous sexual history,
including evidence of previously acquired STIs, as part of an effort to
undermine the credibility of the survivor’s testimony. In addition, due to
current testing methods using nucleic acid amplification (NAAT), STI tests
have been found to be positive as a result of an assault even when obtained
within 72 hours of the assault. Alternatively, because the prevalence of STIs
in prepubertal patients is quite low, occurring in less than 5% to 10% of
prepubertal victims, the AAP and Centers for Disease Control and
Prevention (CDC) recommend targeted screening in this age group. It is
recommended that prepubertal victims be screened for STIs if signs or
