- Keywords > Clinical Practice Guidelines (CPGs)
- Keywords > criteria of medicines selection
- Keywords > HIV infection and STIs
- Keywords > opportunistic infections and other HIV-related
- Keywords > reproductive tract infections
- Keywords > sexual and reproductive health
- Keywords > sexually transmitted infections (STIs)
- Keywords > treatment guidelines
- Keywords > treatment protocols
(2004; 88 pages)
6. CHILDREN6, ADOLESCENTS AND SEXUALLY TRANSMITTED INFECTIONS
6 WHO defines children as persons between the ages of 0 - 9 years.
During the past decade, sexual abuse of children and adolescents has come to be recognized as a serious social problem requiring the attention of policy-makers, educators, and the variety of professionals who deliver social and health services. As researchers begin to document the serious effects of sexual abuse on the mental, emotional and physical health of this group, the management of the victims is emerging as an important aspect of child and adolescent health care in both the industrialized and the developing world.
A standardized approach to the management of sexually transmitted infections in children and adolescents who are suspected of having been sexually abused is important because the infection may be asymptomatic. An STI which remains undiagnosed and untreated may result in an unanticipated complication at a later stage and may be transmitted to others.
Health-care providers have not always been aware of the link between sexual abuse and STI in children. Previously, children suspected of having been sexually abused were not screened routinely for STI. Conversely, children diagnosed with an STI were not investigated for the source of infection, but were assumed to have acquired the infection by non-sexual means, such as a contaminated towel or overcrowded sleeping arrangements bringing them into contact with an infected person.
The identification of a sexually transmissible agent in a child beyond the neonatal period, in the vast majority of cases, is suggestive of sexual abuse. However, exceptions do exist, e.g. rectal or genital infection with C. trachomatis in young children may be due to perinatally acquired infection, which may persist for up to 3 years. In addition, bacterial vaginosis and genital mycoplasma have been identified in both abused and non-abused children. Genital warts, although suggestive of assault, are not specific for sexual abuse without other evidence. When the only evidence of sexual abuse is the isolation of an organism or the detection of antibodies to a sexually transmissible agent, findings should be carefully confirmed and considered.
In adolescents, cases of sexual abuse of both sexes are probably far more widespread than commonly recognized. Most cases of sexual abuse involve relatives, friends and other adults in close and legitimate contact with the child or adolescent. The perpetrator may be difficult to identify. Health workers who suspect abuse must consider the options available for specialized counselling, social support and redress.
It must be stressed that the psychological and social support services should be included for complete management of these patients.