Paeds · child-safety-and-social-paediatrics
Sexually transmitted infections and child sexual abuse
Also known as Child sexual abuse evaluation · STI as a marker of sexual abuse · Prepubertal STI interpretation · Forensic sexual abuse examination · Sexual assault STI prophylaxis in children · Anogenital examination in suspected abuse
A fellowship approach to sexually transmitted infections (STIs) in the context of child sexual abuse: a trauma-informed, forensic-aware evaluation in which an STI is read as a graded marker of sexual contact rather than a routine infection, with age- and pathogen-specific interpretation of NAAT results, targeted forensic sample collection within the evidence window, STI and HIV post-exposure prophylaxis, mandated reporting across jurisdictions, and multidisciplinary safety planning for ANZ, UK, US and Canada.
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Practise this topic
Target exams
Red flags
- Acute anogenital bleeding, injury or pain after a disclosure of contact
- Disclosure of penetration or an assault within the forensic evidence window
- Ongoing access to the child by the alleged perpetrator
- Gonococcal infection at any non-conjunctival site in a prepubertal child beyond the neonatal period
- Acquired syphilis, Trichomonas vaginalis or HIV in a child with no credible non-sexual route
- Suicidality, self-harm or acute dissociation at the time of disclosure
- A caregiver refusing the examination or attempting to supervise the disclosure interview
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Child protection and forensic paediatrics
- Sexually transmitted infections and child sexual abuse evaluation
- Current 2026 PREP curriculum — Child Protection and Forensic Paediatrics: medical evaluation of suspected child sexual abuse and STI interpretation
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics including safeguarding
- Clinical Applications
- Child sexual abuse evaluation and STI management
- Long Cases
- Short Cases
- Communication stations
- 2. Safeguarding: Recognises and responds to child abuse and neglect
- 8. Child protection and forensic assessment
- 11. Adolescent health: sexually transmitted infections and assault
- General Paediatrics: Performs a trauma-informed forensic evaluation of suspected child sexual abuse and interprets STI findings
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Child protection, safeguarding and sexual abuse evaluation
- History
- Communication
- Clinical
- General Pediatrics Content Outline — Domain 4: Child Advocacy and Child Abuse
- General Pediatrics Content Outline — Domain 12: Infectious Diseases (STIs)
- General Pediatrics EPA 9: Recognising and responding to child abuse and neglect
- Patient Care 1: History and Physical Examination
- Patient Care 5: Patient Management
- Systems-Based Practice 2: Safeguarding and mandated reporting
- Professionalism 1: Professional Behavior and Ethical Principles
- Professionalism 5: Confidentiality, consent and child rights
- Advocate
- Professional
- Collaborator
- Pediatrics: Foundations EPA — Recognising and responding to child maltreatment
Overview & Definition
A four-year-old presents with vaginal discharge. A swab returns gonorrhoea. The easy, dangerous move is to treat the infection and move on. The fellowship move is to recognise that gonococcal infection at a non-conjunctival site in a prepubertal child is a strong marker of sexual contact, and that the laboratory result is the start of a safeguarding process, not its conclusion. [1] [7]
Child sexual abuse is the involvement of a child in sexual activity that they cannot consent to, do not fully comprehend, or are developmentally unready for, including contact and non-contact acts. Sexually transmitted infections in children must therefore be read along two axes: they are clinical infections to diagnose and treat, and they are forensic signals whose strength as evidence of sexual contact depends on the pathogen, the child's age, and the exclusion of non-sexual transmission. [1] [2]
The central shift in thinking for this topic is that a positive STI test is never an isolated laboratory event in a child. A swab result has to be interpreted against perinatal acquisition (which can persist for years), autoinoculation and fomite transmission, known blood-borne exposure, and the child's disclosure and examination findings before it carries medico-legal weight. [7] [8]
Core sequence of an abuse-and-STI evaluation
- 1
Safety first
Confirm the child is safe now; address acute injury, bleeding or suicidality before any planned examination.
- 2
Trauma-informed history
Child-led disclosure; never interrogate. Capture perinatal, immunisation, menstrual and pregnancy context.
- 3
Targeted examination
General plus anogenital exam in a trained setting, with consent, chaperone and photo-documentation.
- 4
Risk-stratified testing
STI testing by age, risk and site; forensic samples if within the evidence window.
- 5
Prophylaxis and safety
STI/HIV prophylaxis, emergency contraception, mandated report and multidisciplinary follow-up.
References15ShowHide
- [1]Adams JA, Kellogg ND, Farst KJ, Harper NS, Palusci VJ, Frasier LD Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused. J Pediatr Adolesc Gynecol, 2016.PMID 26220352
- [2]Kellogg N The evaluation of sexual abuse in children. Pediatrics, 2005.PMID 16061610
- [3]Kellogg ND Clinical report--the evaluation of sexual behaviors in children. Pediatrics, 2009.PMID 19720674
- [4]Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep, 2021.PMID 34292926
- [5]Seña AC, Hsu KK, Kellogg N, et al. Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children. Clin Infect Dis, 2015.PMID 26602623
- [6]Girardet RG, Lemme S, Biason TA, Bolton K, Lahoti S HIV post-exposure prophylaxis in children and adolescents presenting for reported sexual assault. Child Abuse Negl, 2009.PMID 19324415
- [7]Hammerschlag MR Use of nucleic acid amplification tests in investigating child sexual abuse. Sex Transm Infect, 2001.PMID 11402219
- [8]Bechtel K Sexual abuse and sexually transmitted infections in children and adolescents. Curr Opin Pediatr, 2010.PMID 19952927
- [9]Christian CW, Lavelle JM, De Jong AR, Loiselle J, Brenner L, Joffe M Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics, 2000.PMID 10878156
- [10]Christian CW Timing of the medical examination. J Child Sex Abus, 2011.PMID 21970643
- [11]Hornor G, Benzinger E, Doughty K, Hollar J, Wolf K Pediatric Forensic Analysis: The Benefits of DNA Collection Beyond 24 Hours. J Forensic Nurs, 2022.PMID 35149664
- [12]Hailes HP, Yu R, Danese A, Fazel S Long-term outcomes of childhood sexual abuse: an umbrella review. Lancet Psychiatry, 2019.PMID 31519507
- [13]Awasthi S, Ornelas J, Armstrong A, Johnson JA, Eisen DB Anogenital warts and relationship to child sexual abuse: Systematic review and meta-analysis. Pediatr Dermatol, 2021.PMID 34060139
- [14]GBD 2023 Intimate Partner Violence and Sexual Violence against Children Collaborators Disease burden attributable to intimate partner violence against females and sexual violence against children in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet, 2026.PMID 41386261
- [15]Adams JA, Kaplan RA, Starling SP, Mehta NH, Finkel MA, Botash AS Guidelines for medical care of children who may have been sexually abused. J Pediatr Adolesc Gynecol, 2007.PMID 17561184