Assessment for sexual abuse in a case presenting with genital herpes

Abstract

Child sexual abuse is defined as the use of a child by an adult or a significantly older person for the purpose of sexual stimulation. Sexual relations within the family (incest) "particularly involving children" is prohibited in all faiths and societies; hence, incestuous child sexual abuse is the form of abuse most difficult to determine. Prepubertal genital herpes is a presentation that definitely needs to be assessed as a potential indication for sexual abuse. Even though in adults transmission is often by sexual route, it has been pointed out that especially in cases below the age of 5 years, anogenital herpes can be transmitted by non-sexual mechanisms. As paths for a possible non-sexual transmission of genital herpes, autoinoculation, finger contact by an adult changing nappies leading to infection, hand contact between children, or transmission via infected objects (plate, fork, garments, etc.) have been reported. Guidelines helping in the assessment of sexual abuse are insufficient regarding the question how the issue should be confronted in pediatric cases of genital herpes. More evidence is required to solve this problem. In our presentation, we discuss the process of assessment for sexual abuse in the case of a girl aged 2 years 3 months presenting to the emergency department with anogenital herpes.