Gonorrheal and chlamydia yield for genital and extragenital testing in children evaluated for sexual abuse.

Objective: Texas Forensic Nurse Examiners (TXFNE) performs routine testing of genital and non-genital sites for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), and further testing for other sexually transmitted pathogens. The current Centers for Disease Control and Prevention (CDC) guidelines recommend that testing be based primarily on patient history of type of sexual contact, patient age, community prevalence of sexually transmitted infections (STIs), perpetrator risk factors for STIs, and patient symptoms (Centers for Disease Control and Prevention, 2021). In this study, we were interested in determining whether our practice of testing all sites in all prepubertal patients presenting for sexual abuse for CT and NG resulted in identification of infections that would have been missed if testing had been limited to disclosed sites of sexual contact.

Evaluation for Bleeding Disorders in Suspected Child Abuse.

Bruising or bleeding in a child can raise the concern for child abuse. Assessing whether the findings are the result of trauma and/or whether the child has a bleeding disorder is critical. Many bleeding disorders are rare, and not every child with bruising/bleeding that may raise a concern for abuse requires an evaluation for bleeding disorders.

Evaluation of an Intensive Program for Children With Co-occurring Medical and Emotional Disorders.

The study objective was to assess clinical outcomes and cost avoidance of an intensive day treatment program for children with co-occurring chronic medical disease and emotional problems. Intensive day treatment programs for this population are uncommon, and their effectiveness has not been previously reported. A total of 175 children were enrolled during the 3-year study period.

Risk factors for nonaccidental burns in children.

Background: The relative influences of baseline risk factors for pediatric nonaccidental burns have not been well described. We evaluated baseline characteristics of pediatric nonaccidental burn patients and their primary caretakers.

Methods: A single-center retrospective cohort study was conducted of pediatric (age < 17) burn patients from July 1, 2013, to June 30, 2018.

Child protective services utilization of child abuse pediatricians: A mixed methods study.

Several children's hospitals and medical schools across Texas have child abuse pediatricians (CAPs) who work closely with child protection workers to help ensure accurate assessments of the likelihood of maltreatment in cases of suspected abuse and neglect. Since the state does not mandate which cases should be referred to a CAP center, we were interested in studying factors that may influence workers' decisions to consult a CAP. We used a mixed methods study design consisting of a focus group followed by a survey.

Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children.

Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure.

Development of PCR assays for detection of Trichomonas vaginalis in urine specimens.

Trichomonas vaginalis infections are usually asymptomatic or can result in nonspecific clinical symptoms, which makes laboratory-based detection of this protozoan parasite essential for diagnosis and treatment. We report the development of a battery of highly sensitive and specific PCR assays for detection of T. vaginalis in urine, a noninvasive specimen, and development of a protocol for differentiating among Trichomonas species that commonly infect humans.

Anogenital human papillomavirus in sexually abused and nonabused children: a multicenter study.

Objectives: To characterize the epidemiology of genital human papillomavirus (HPV) infection in children without previous consensual sexual activity, comparing HPV prevalence by certainty of child sexual abuse (CSA).

Patients And Methods: Patients presenting for evaluation of CSA in 8 sites in Atlanta, Houston, Harrisburg, and New York City were recruited along with patients presenting for unrelated health visits. CSA certainty was classified as definite, probable, possible, or no evidence following published guidelines and the results of history, physical examination, and laboratory tests.

Collection of forensic evidence from pediatric victims of sexual assault.

Objective: To determine the time period after sexual assault of a child that specimens may yield evidence using DNA amplification. Secondary questions included the comparative laboratory yields of body swabs versus other specimens, and the correlation between physical findings and laboratory results.

Patients And Methods: Data from evidence-collection kits from children 13 years and younger were reviewed.

Epidemiology of sexually transmitted infections in suspected child victims of sexual assault.

Objective: The objective of this study was to describe the epidemiology of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, HIV, and herpes simplex virus type 2 (HSV-2) infection diagnosed by culture or by serologic or microscopic tests and by nucleic acid amplification tests in children who are evaluated for sexual victimization.

Methods: Children aged 0 to 13 years, evaluated for sexual victimization, who required sexually transmissible infection (STI) testing were enrolled at 4 US tertiary referral centers. Specimens for N gonorrhoeae and C trachomatis cultures, wet mounts for detection of T vaginalis, and serologic tests for syphilis and HIV were collected and processed according to study sites' protocols.

Multicenter study of nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in children being evaluated for sexual abuse.

Background: Diagnosis of sexually transmitted infections in children suspected of sexual abuse is challenging due to the medico-legal implications of test results. Currently, the forensic standard for diagnosis of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections is culture. In adults, nucleic acid amplification tests (NAATs) are superior to culture for CT, but these tests have been insufficiently evaluated in pediatric populations for forensic purposes.

HIV post-exposure prophylaxis in children and adolescents presenting for reported sexual assault.

Background: The appropriate use of antiretroviral medications to protect against infection with human immunodeficiency virus (HIV) is unclear in cases of sexual assault of children, for whom the perpetrator's risk of HIV is often unknown, and physical proof of sexual contact is usually absent.

Objective: In an effort to clarify prescribing practices for HIV post-exposure prophylaxis (PEP) at our institution, we examined records of all children tested for HIV for prevalence of infection, our experience with prescribing PEP, and follow-up rates.

Design/methods: Medical records at a sexual abuse clinic of all children tested for HIV during a 38-month period were reviewed for information concerning risk factors for HIV acquisition, STI test results, and PEP experience.

Unmet health care needs among children evaluated for sexual assault.

Objectives: To determine in a population of children who underwent a medical examination after alleged sexual assault the proportion who had unmet medical or psychiatric needs.

Design: Retrospective medical record review.

Setting: A referral center for alleged child victims of sexual assault in Houston, Tex, from December 1, 2003, through April 30, 2004.

Two cases of anal fistula in girls evaluated for sexual abuse.

Anal fistulae are seen infrequently in the pediatric population. They are most commonly encountered in otherwise healthy boys less than 1 year of age. In the scant literature regarding pediatric anal fistulae, the majority of studies and case reports involve children less than 1 year of age.