Sexually transmitted infection testing in prepubertal and peripubertal children–recognizing indications+ Flashcards
When should sexual abuse in children be suspected?
In a child if they notice any unusual pattern in child’s injury or behavior.
And what general age range does most sexual abuse occur in children?
Prepubertal and peripubertal years
Of boys and girls who is more likely to be sexually abused and who is less likely to report it?
Girls are more likely to be victim of sexual abuse, boys are less likely to report being a victim.
What is the prevalence of STDs in pediatric sexual abuse victims?
5 to 8% a pediatric sexual abuse victims.
When should physicians consider screening for STDs in prepubertal children (10 indications)?
If the interview suggest sexual abuse
Suspected sexual abuse or is a stranger
Clinical signs and symptoms or symptoms of STD
Patient already diagnosed with a prior STD
Patient’s sibling or other close/family member who also as a child was diagnosed with an STD
Suspected sexual abuse or has an STD or is at high risk for having an STD
Evidence of penetration in either of the genitals or anus
Evidence of ejaculation or semen
Patient lives in an area with high rates of STDs
Patient or guardian requests STD screening.
In post pubertal adolescents what other controversies for screening for STDs? Delete
Controversy around whether to screen for STDs and postpubertal adolescents who have been sexually active simply because STDs can be asymptomatic thus it is a case by case basis especially if screening is needed for treatment.
What are some of the physical findings suspicious for sexual abuse and consideration for STD screening?
+Genital discharge
Injuries in the genital or anal rectal area that require surgery
Hymen with a deep notch in the posterior inferior rim
A hymen with a thin posterior rim
A hymen with a wide orifice
Any lesions that look like genital warts
Any ulcers or vesicular lesions in the anal genital area
Significant anal dilation 2 cm more
What are the 5 general areas of the differential for sexual abuse?
- Injuries
- Infections
- Skin conditions
- Anal condition
- Urethral conditions
What are some of the presenting findings for injuries in the differential of sexual abuse.
Injuries to the perineum or genitalia can occur unintentionally including straddle injuries, entrapment with clothing zipper, hair tourniquets, or motor vehicle accidents.
What are some of the presenting findings for infections in the differential diagnosis of sexual abuse?
Erythema or inflammation of the perineum from pathogens such as strep vaginitis, Candida, varicella, perianal cellulitis, pinworms and autoinoculation of molluscum contagiosum.+
What are some of the presenting findings for skin conditions in the differential diagnosis of sexual abuse
Erythema, bleeding, ulcers and friability of the perineum due to different dermatologic conditions such as nonspecific vulvovaginitis, poor hygiene, seborrheic dermatitis, atopic dermatitis, contact dermatitis, lichen sclerosis, lichen simplex, lichen planus, psoriasis, bullous pemphigoid, Behcet syndrome, hemangiomas in the perianal area and congenital dermal melanocyte ptosis.
What are some of the presenting findings for anal conditions in the differential diagnosis of sexual abuse?
Perianal bleeding or bruising, hemorrhoids, Crohn’s disease, rectal prolapse, hemolytic uremic syndrome, rectal tumors. Perianal erythema from encopresis, poor hygiene, and infections that are not sexually transmitted.
What are some of the presenting findings for urethral conditions in the differential diagnosis for sexual abuse?
Urethral prolapse, ureteroceles, sarcoma Bacteroides and caruncles
When doing STD screening what pathogen should be included in the screening?
Screening test should include gonorrhea, chlamydia, trichomonas, and bacterial vaginosis, HIV and syphilis, hepatitis B and other.
In the situation of the patient not being treated with prophylactic antibiotics For the bacterial pathogens of gonorrhea, chlamydia, trichomonas, bacterial vaginosis, when should screening test for STDs be done?
Screening should be done 2 weeks after an event occurred since this is the incubation period for mouth disease pathogens
