Sexually transmitted infections - advice when child maltreatment (sex abuse) should be suspected or considered

Sexually transmitted infections

• features where sexual abuse should be suspected - to suspect child maltreatment means a serious level of concern about the possibility of child maltreatment but is not proof of it
  
  
  • suspect sexual abuse if a child younger than 13 years has gonorrhoea, chlamydia, syphilis, genital herpes, hepatitis C, HIV or trichomonas infection unless there is clear evidence of mother-to-child transmission during birth or blood contamination
    
    
• features where sexual abuse should be considered - to consider child maltreatreatment means that one possible explanation for the alerting feature or is included in the differential diagnosis
  
  
  • consider sexual abuse if a child younger than 13 years has hepatitis B unless there is clear evidence of mother-to-child transmission during birth, non-sexual transmission from a member of the household or blood contamination
    
    
  • consider sexual abuse if a child younger than 13 years has anogenital warts unless there is clear evidence of mother-to-child transmission during birth or non-sexual transmission from a member of the household
    
    
  • consider sexual abuse if a young person aged 13 to 15 years has hepatitis B unless there is clear evidence of mother-to-child transmission during birth, non-sexual transmission from a member of the household, blood contamination or that the infection was acquired from consensual sexual activity with a peer
    
    
  • consider sexual abuse if a young person aged 13 to 15 years has anogenital warts unless there is clear evidence of mother-to-child transmission during birth, non-sexual transmission from a member of the household, or that the infection was acquired from consensual sexual activity with a peer
    
    
  • consider sexual abuse if a young person aged 13 to 15 years has gonorrhoea, chlamydia, syphilis, genital herpes, hepatitis C, HIV or trichomonas infection unless there is clear evidence of mother-to-child transmission during birth, blood contamination, or that the sexually transmitted infection (STI) was acquired from consensual sexual activity with a peer
    
    
  • consider sexual abuse if a young person aged 16 or 17 years has hepatitis B and there is:
    • no clear evidence of mother-to-child transmission during birth, non-sexual transmission from a member of the household, blood contamination or that the infection was acquired from consensual sexual activity and
    • a clear difference in power or mental capacity between the young person and their sexual partner, in particular when the relationship is incestuous or is with a person in a position of trust (for example, teacher, sports coach, minister of religion) or
    • concern that the young person is being exploited
      
      
  • consider sexual abuse if a young person aged 16 or 17 years has anogenital warts and there is:
    • no clear evidence of non-sexual transmission from a member of the household or that the infection was acquired from consensual sexual activity and
    • a clear difference in power or mental capacity between the young person and their sexual partner, in particular when the relationship is incestuous or is with a person in a position of trust (for example, teacher, sports coach, minister of religion) or
    • concern that the young person is being exploited
      
      
  • consider sexual abuse if a young person aged 16 or 17 years has gonorrhoea, chlamydia, syphilis, genital herpes, hepatitis C, HIV or trichomonas infection and there is:
    • no clear evidence of blood contamination or that the STI was acquired from consensual sexual activity and
    • a clear difference in power or mental capacity between the young person and their sexual partner, in particular when the relationship is incestuous or is with a person in a position of trust (for example, teacher, sports coach, minister of religion) or
    • concern that the young person is being exploited

Reference:

• -1. NICE (July 2009). When to suspect child maltreatment