小结
定义
病史和体格检查
关键诊断因素
- 披露不适当的接触
- 急性生殖器创伤（变化）；处女膜横断或缺失（儿童）
- 性传播感染
其他诊断因素
- 生殖器检查的结果一般是正常的
- 情绪和心理障碍
- 肛门及生殖器病变
- 阴唇与会阴损伤
- 非生殖器损伤
- 阴道或阴茎溢液
- 伤害行为
- 儿童性行为问题
- 儿童慢性医学疾病
- 频繁发生或顽固性泌尿生殖系统疾病
- 处女膜凹痕
危险因素
- 家里的其他孩子被性虐待
- 儿童期遭受亲密伴侣暴力
- 青少年和年轻女性
- 残疾
- 贫困和无家可归人群
- 性工作者
- 居住于社会收容机构或者冲突地区的人群
- 服用酒精或者其它药物的人群
诊断性检查
首要检查
- 法医学标本
- 淋病奈瑟菌检测
- 沙眼衣原体检测
- 梅毒血清检测
- 乙型肝炎血清学检测
- HIV 血清学
- 尿 β-人绒毛膜促性腺激素
- 阴道滴虫检测
- 肛门生殖器样本培养：单纯疱疹病毒聚合酶链反应（Polymerase chain reaction, PCR）
- 肝功能检测 (LFT)
- 肌酐
- 尿素
- 全血细胞计数（FBC）
需考虑的检查
- 艾滋病确诊检测
- 艾滋病病毒核酸扩增检测
- 梅毒螺旋体血凝集试验用于检验梅毒
- 血清梅毒快速血浆反应素检测
治疗流程
受侵犯后72小时内：未进入青春期
受侵犯后72小时内：青少年或成人
受侵犯72小时后：未进入青春期
侵犯发生72小时后：青少年或成人
撰稿人
作者
Sheela Lahoti, MD
Professor
Division of Child Safety and Integrated Care
Department of Pediatrics
University of Texas Medical School at Houston
Houston
TX
利益声明
SL declares that she has no competing interests.
Rebecca Girardet, MD
Professor
Division of Child Safety and Integrated Care
Department of Pediatrics
University of Texas Medical School at Houston
Houston
TX
利益声明
RG is a Paediatric Co-Leader for the STI chapter for the Royal College of Paediatrics and Child Health 'Purple book'. This is an unpaid advisory position.
Simi Abraham, MD
Assistant Professor
Division of Child Protection Pediatrics
Department of Pediatrics
University of Texas Medical School at Houston
Houston
TX
利益声明
SA gives expert testimony in cases and delivers educational lectures on this subject.
Michelle Ruda, MD
Assistant Professor
Division of Child Safety and Integrated Care
Department of Pediatrics
University of Texas Medical School at Houston
Houston
TX
利益声明
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
利益声明
MM declares that she has no competing interests.
Ashley Gibson, MD
Assistant Professor
Department of Pediatrics
UT Health Houston
Houston
TX
利益声明
AG is employed by the University of Texas Health Science Center at Houston. She has given expert testimony in cases of child abuse and neglect. She has applied for an institutional grant related to screening for social determinants of health.
鸣谢
Dr Sheela Lahoti, Dr Rebecca Girardet, Dr Michelle Ruda, Dr Simi Abraham, Dr Margaret McNeese, and Dr Ashley Gibson 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.
利益声明
CG, SG, and JW declare that they have no competing interests.
同行评议者
James Lukefahr, MD
Professor of Pediatrics
Child Abuse Division
Department of Pediatrics
University of Texas Health Science Center
San Antonio
TX
利益声明
JL declares that he has no competing interests.
Suzanne Starling, MD
Medical Director
CHKD-CAP
Professor of Pediatrics
Eastern Virginia Medical School
Norfolk
VA
利益声明
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
利益声明
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
利益声明
RG declares that she has no competing interests.
鉴别诊断
- 硬化性苔藓
- 尿道黏膜脱垂
- 痣
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