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 human chorionic gonadotropin
- testing for trichomonas
- anogenital culture: herpes simplex virus polymerase chain reaction (PCR)
- LFT
- creatinine
- BUN
- CBC
Investigations to consider
- HIV confirmatory test
- HIV RNA PCR
- Treponema pallidum hemagglutination assay for syphilis
- serum rapid plasma reagin for syphilis
Treatment algorithm
within 72 to 96 hours since assault: preadolescent
within 72 to 96 hours since assault: adolescent or adult
>96 hours since assault: preadolescent
>96 hours since assault: adolescent or adult
Contributors
Authors
Sheela Lahoti, MD
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.
Rebecca Girardet, MD
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.
Shaina Groisberg, MD
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.
Michelle Ruda, MD
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.
Margaret McNeese, MD
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.
Acknowledgements
Dr Sheela Lahoti, Dr Rebecca Girardet, Dr Shaina Groisberg, Dr Michelle Ruda, and Dr Margaret McNeese would like to gratefully acknowledge Dr Zoe O'Connor, pediatric resident from Niklaus Children’s Hospital in Miami, Florida, for her contribution to this topic, and Dr Christopher Greeley and Dr Jan Welch, previous contributors to this topic. CG and JW declare that they have no competing interests.
Peer reviewers
James Lukefahr, MD
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.
Suzanne Starling, MD
Medical Director
CHKD-CAP
Professor of Pediatrics
Eastern Virginia Medical School
Norfolk
VA
Disclosures
SS is an author of a reference cited in this topic. SS declares that she has no other competing interests.
Angelo P. Giardino, MD, PhD
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.
Ruth Gilbert, MD, MSc, MB ChB
Professor of Clinical Epidemiology
UCL-Institute of Child Health
London
UK
Disclosures
RG declares that she has no competing interests.
Differentials
- Lichen sclerosus
- Urethral prolapse
- Nevus
More DifferentialsGuidelines
- Updated guidelines for the medical assessment and care of children who may have been sexually abused
- Sexually transmitted diseases treatment guidelines, 2015
More GuidelinesPatient leaflets
Chlamydia
Genital herpes
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