Summary
Definition
History and exam
Key diagnostic factors
- declaração de contato inapropriado
- trauma anogenital agudo ou residual (cicatrização) (qualquer alteração); evidência de trauma no hímen (em crianças)
- infecções sexualmente transmissíveis
Other diagnostic factors
- achados genitais normais
- sequelas emocionais e psicológicas
- lesões anogenitais
- lesões não genitais
- corrimento vaginal ou peniano
- comportamentos nocivos
- problemas de comportamento sexual em crianças
- queixas médicas crônicas de crianças
- queixas geniturinárias frequentes ou persistentes
- lacerações no hímen
Risk factors
- abuso sexual de outras crianças no domicílio
- exposição na infância a violência de parceiro íntimo
- família monoparental
- adolescentes e mulheres jovens
- deficiência de aprendizagem ou física
- Problemas de saúde mental
- pobreza ou falta de moradia
- profissionais do sexo
- vivendo em instituições ou áreas de conflito
- uso de bebidas alcoólicas ou outras drogas
Diagnostic investigations
1st investigations to order
- espécimes forenses
- testes para Neisseria gonorrhoeae
- testes para Chlamydia trachomatis
- exames sorológicos para sífilis
- testes sorológicos para hepatite B
- sorologia do HIV
- gonadotrofina coriônica humana beta na urina
- teste para Trichomonas vaginalis
- cultura anogenital: reação em cadeia da polimerase para vírus do herpes simples
- testes da função hepática
- creatinina
- ureia
- Hemograma completo
Investigations to consider
- exame confirmatório para o HIV
- reação em cadeia da polimerase do ácido ribonucleico (RNA) do HIV
- ensaio de hemaglutinação para Treponema pallidum para sífilis
- reagina plasmática sérica rápida para sífilis
- testes sorológicos para hepatite C
Treatment algorithm
≤72 horas desde a agressão: crianças pré-púberes
≤72 horas desde a agressão: adolescente ou adulto
>72 horas desde a agressão: crianças pré-púberes
>72 horas desde a agressão: adolescente ou adulto
Contributors
Authors
Sheela Lahoti, MD
Professor
Division of Child Safety and Integrated Care
Department of Pediatrics
University of Texas Medical School at Houston
Houston
TX
Disclosures
SL declares that she has no competing interests.
Rebecca Girardet, MD
Professor
Pediatrics Child Abuse Services
Department of Pediatrics
University of New Mexico
Albuquerque
NM
Disclosures
RG will likely provide expert testimony for a private firm in Albuquerque, NM, on a child sexual abuse civil case in 2025. RG is a member of the American Academy of Pediatrics Executive Committee on Child Abuse and Neglect. RG is the principal investigator for service grants from the New Mexico Crime Victims Reparation Commission that supports child sexual abuse programs at the University of New Mexico.
Simi Abraham, MD
Assistant Professor
Division of Child Safety and Integrated Care
Department of Pediatrics
University of Texas Medical School at Houston
Houston
TX
Disclosures
SA gives expert testimony in cases on this subject.
Michelle Ruda, MD
Associate Professor
Division of Child Safety and Integrated Care
Department of Pediatrics
University of Texas Medical School at Houston
Houston
TX
Disclosures
MR declares that she has no competing interests.
Margaret McNeese, MD
Professor
Division of Community and General Medicine
Department of Pediatrics
University of Texas Medical School at Houston
Houston
TX
Disclosures
MM declares that she has no competing interests.
Ashley Gibson, MD
Assistant Professor
Division of Child Safety and Integrated Care
Department of Pediatrics
UT Health Houston
Houston
TX
Disclosures
AG declares that she has no competing interests.
Arezo Nasrazadani, MD
Assistant Professor
Division of Child Safety and Integrated Care
Department of Pediatrics
UT Health Houston
Houston
TX
Disclosures
AN declares that she has no competing interests.
Acknowledgements
Dr Sheela Lahoti, Dr Rebecca Girardet, Dr Michelle Ruda, Dr Simi Abraham, Dr Margaret McNeese, Dr Ashley Gibson, and Dr Arezo Nasrazadani would like to gratefully acknowledge Dr Zoe O'Connor for her contribution to this topic, and Dr Christopher Greeley, Dr Shaina Goldsmith, and Dr Jan Welch, previous contributors to this topic.
Disclosures
CG, SG, and JW declare that they have no competing interests.
Peer reviewers
Cindy W. Christian, MD
Professor of Pediatrics
University of Pennsylvania
Perelman School of Medicine
Philadelphia
PA
Disclosures
CWC provides medical legal expertise in child abuse cases.
Christopher C. Stewart, MD
Professor of Pediatrics
University of California
San Francisco
CA
Disclosures
CCS 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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Workowski KA, Bachmann LH, Chan PA, et al; Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Full text Abstract
British Association of Sexual Health and HIV. BASHH national guideline on the management of sexually transmitted infections and related conditions in children and young people. 2021 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Líquen escleroso
- Prolapso uretral
- Nevo
More DifferentialsGuidelines
- Recommendations for the collection of forensic specimens from complainants and suspects
- FFLM quality standards for clinicians undertaking paediatric sexual offence medicine
More GuidelinesPatient information
Clamídia
Verrugas genitais
More Patient information
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