SEXUALLY-TRANSMITTED DISEASES IN SEXUALLY ABUSED-CHILDREN - MEDICAL AND LEGAL IMPLICATIONS

Sexually transmitted diseases (STDs) may be transmitted during sexual assault. In children, the isolation of a sexually transmitted organism may be the first indication that abuse has occurred. Although the pre sence of a sexually transmissible agent from a child beyond the neonat al period is suggestive of sexual abuse, exceptions do exist. In this review I discuss the issues of the transmissibility and diagnosis of S TDs in the context of child sexual abuse. Rectal or genital infection with Chlamydia trachomatis among young children may be the result of p erinatally acquired infection and may persist for as long as 3 years. A major problem with chlamydia testing in the context of suspected sex ual abuse in children has been the inappropriate use of non-culture te sts. Although the new generation of nucleic acid amplification tests h ave shown high sensitivity and specificity with genital specimens from adults, data on use of these tests on any site in children are practi cally non-existent. Bacterial vaginosis (BV) has been identified among children who have been abused and among those who have not been abuse d. However, many of the methods used to diagnose BV in adults have not been evaluated in children. Recent studies of perinatal infection wit h human papillomavirus (HPV) have been inconclusive. HPV DNA has been detected at various sites in children who have not been abused. The re lation to the development of clinically apparent genital warts is uncl ear. Although HIV can be acquired through sexual abuse in children, th e exact risk to the child and which children should be screened is sti ll controversial.