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Evaluating children for sexual assault or abuse should be conducted in a manner designed to minimize pain and trauma to the child. Examinations and collection of vaginal specimens in prepubertal girls can be extremely uncomfortable and should be performed by an experienced clinician to avoid psychological and physical trauma to the child. The decision to obtain genital or other specimens from a child to evaluate for STIs should be made on an individual basis. However, children who received a diagnosis of one STI should be screened for other STIs. History and reported type of sexual contact might not be a reliable indicator, and urogenital, pharyngeal, and rectal testing should be considered for preverbal children and children who cannot verbalize details of the assault (1438,1449). Factors that should lead the physician to consider testing for STIs include the following (1449):

The risk for a child acquiring an STI as a result of sexual abuse or assault has not been well studied. Presumptive treatment for children who have been sexually assaulted or abused is not recommended because the incidence of most STIs among children is low after abuse or assault, prepubertal girls appear to be at lower risk for ascending infection than adolescent or adult women, and regular follow-up of children usually can be ensured. However, certain children or their parent or guardian might be concerned about the possibility of infection with an STI, even if the health care provider has perceived the risk to be low. Such concerns might be an indication for presumptive treatment in certain settings and might be considered after all relevant specimens for diagnostic tests have been collected.

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