Pediatric emergency medicine trisk 4240 4240
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TABLE 127.4
IMPLICATIONS OF COMMONLY ENCOUNTERED SEXUALLY
TRANSMITTED (ST) OR SEXUALLY ASSOCIATED (SA)
INFECTIONS FOR DIAGNOSIS AND REPORTING OF SEXUAL
ABUSE AMONG INFANTS AND PREPUBERTAL CHILDREN
ST/SA confirmed
Evidence for sexual Suggested action
abuse
Gonorrhea a
Syphilis a
HIV c
Chlamydia trachomatis a
Trichomonas vaginalis a
Genital herpes
Diagnostic
Diagnostic
Diagnostic
Diagnostic
Highly suspicious
Highly suspicious
(HSV-2 especially)
Suspicious
Condylomata acuminata
(anogenital warts) a
Bacterial vaginosis
Report b
Report b
Report b
Report b
Report b
Report b , d
Consider report b , d ,
e
Inconclusive
Medical follow-up
a If
not likely to be perinatally acquired and rare vertical transmission is excluded.
should be made to the agency in the community mandated to receive reports of suspected
child abuse or neglect.
c If not likely to be acquired perinatally or through transfusion.
d Unless a clear history of autoinoculation exists.
e Report if evidence exists to suspect abuse, including history, physical examination, or other
identified infections.
HIV, human immunodeficiency virus; SA, sexually associated; ST, sexually transmitted.
Adapted from Kellogg N; American Academy of Pediatrics Committee on Child Abuse and Neglect.
The evaluation of child abuse in children. Pediatrics 2005;116:506–512.
b Reports
For all patients, determination of which sites to sample is based on areas
of possible contact with assailant’s bodily fluids and includes vaginal,
urethral, anorectal, oropharyngeal, and/or blood. As the history of the assault
provided or recalled may change with time, the clinician should consider
testing for STIs from multiple sources. Nucleic acid amplification tests
(NAATs) on urine specimens for GC, CT, and trichomonas have essentially
