Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • disclosure of inappropriate contact
  • acute anogenital trauma (any change); transections and absent hymen (in children)
  • HIV infection

Other diagnostic factors

  • normal genital findings
  • depression
  • anogenital lesions
  • labia and perineum injury
  • nongenital injuries
  • vaginal or penile discharge
  • self-destructive behavior
  • sexualized behaviors in children
  • chronic medical complaints in children
  • frequent or persistent genitourinary complaints
  • hymenal notches

Risk factors

  • sexual abuse of other children in the home
  • adolescents and young women
  • disability
  • poverty or homelessness
  • sex workers
  • living in institutions or areas of conflict
  • use of alcohol or other drugs
  • lack of community services

Diagnostic investigations

1st investigations to order

  • forensic specimens
  • culture for Neisseria gonorrhoeae
  • culture for Chlamydia trachomatis
  • nucleic acid amplification for Chlamydia trachomatis and Neisseria gonorrhoeae
  • serologic tests for syphilis
  • HIV serology
  • urine beta HCG
  • testing for trichomonas
  • anogenital culture: herpes simplex virus PCR
  • LFT
  • creatinine
  • BUN
  • CBC
Full details

Investigations to consider

  • HIV confirmatory test
  • HIV RNA PCR
  • Treponema pallidum hemagglutination assay for syphilis
  • serum RPR for syphilis
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor

Department of Pediatrics

Division of Child Protection Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

SL declares that she has no competing interests.

Associate Professor

Department of Pediatrics

Division of Child Protection Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

RG declares that she has no competing interests.

Child Abuse Pediatrics Fellow

Department of Pediatrics

Division of Child Protection Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

SG declares that she has no competing interests.

Child Abuse Pediatrics Fellow

Department of Pediatrics

Division of Child Protection Pediatrics

University of Texas Medical School at Houston

Houston

TX

Disclosures

MR declares that she has no competing interests.

Professor

Department of Pediatrics

Division of Community and General Medicine

University of Texas Medical School at Houston

Houston

TX

Disclosures

MM declares that she has no competing interests.

Dr Sheela Lahoti, Dr Rebecca Girardet, Dr Shaina Groisberg, Dr Michelle Ruda, and Dr Margaret McNeese would like to gratefully acknowledge Zoe O'Connor, a medical student from the University of Texas Medical School, for her contribution to this topic, and Dr Christopher Greeley and Dr Jan Welch, previous contributors to this monograph. CG and JW declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Pediatrics

Child Abuse Division

Department of Pediatrics

University of Texas Health Science Center

San Antonio

TX

Disclosures

JL declares that he has no competing interests.

Medical Director

CHKD-CAP

Professor of Pediatrics

Eastern Virginia Medical School

Norfolk

VA

Disclosures

SS is an author of a reference cited in this monograph. SS declares that she has no other competing interests.

Clinical Associate Professor

Pediatrics

Baylor College of Medicine

Medical Director

Texas Children's Health Plan

Houston

TX

Disclosures

APG declares that he has no competing interests.

Professor of Clinical Epidemiology

UCL-Institute of Child Health

London

UK

Disclosures

RG declares that she has no competing interests.

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