Sexual health and young people

Question 1

Gillick competence

Answer 1

The law under which:
children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options

Question 2

Fraser guidelines

Answer 2

Specific to contraception and sexual health

Advice can be given if:

• sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
• cannot be persuaded to tell parents
• very likely to have sexual intercourse with or without contraceptive treatment
• child’s physical or mental health is likely to suffer unless they received the advice or treatment
• The advice or treatment is in the young person’s best interests.

Question 3

If a child is identified to have rectal CT, what should it be tested for?

Answer 3

LGV

Question 4

What does a chain of evidence involve?

Answer 4

Physician taking sample must seal, label and hand to next person in the chain

Question 5

For chain of evidence samples what should the sample label include?

Answer 5

Name of examinee
Description and site of sample
Date and time of sample
Signatures - physician initiating chain and subsequent custodian

Question 6

In child sex abuse, if a pre-pubertal girl declines trans-hymenal or vulval swab for NAAT, what is the alternative?

Answer 6

Urine sample

Question 7

In child sex abuse, what is the preferred site for swabbing for GC/CT in post-pubertal girls?

Answer 7

endo-cervical (if speculum tolerated)

Question 8

What is the disadvantage of treating empirically for STI following sexual assault?

Answer 8

ONce treatment started, any problems with specimens/chain of evidence cannot be rectified through repeat sampling

Question 9

When should hepatitis B immunoglobulin be considered in a child following sexual assault?

Answer 9

If assailant known eAg or sAg positive

patient attends within 72 hours (can be up to 7 days) of assault

Question 10

What is the most likely mode of transmission of gonorrhoea in pubertal and pre-pubertal children?

Answer 10

Sexual abuse

Question 11

What type of sexual contact is the most likely mode of transmission of chlamydia in prepubertal children?

Answer 11

Penetrative

Question 12

Is the presence of bacterial vaginosis helpful in indicating if sexual abuse has occurred or not?

Answer 12

No

BV found in girls both virgin and sexually active

Question 13

What alternative mode of transmission to sexual abuse may be considered in children with genital herpes?

Answer 13

Autoinoculation

Question 14

Does a positive STI diagnosis in a mother always explain a positive STI diagnosis in a child?

Answer 14

No

Consider alternative modes especially sexual abuse

Question 15

If TV is identified in a child what should be considered the most likely mode of transmission?

Answer 15

Sexual abuse