| Title: Sexually Transmitted Diseases and Child Sexual Abuse Series: Portable Guide Author: Margaret R. Hammerschlag, M.D. Published: June 1996; July 1997; March 2001 Subject: Law enforcement response, STD's 12 pages 15,000 bytes Figures, charts, forms, and tables are not included in this ASCII plain-text file. To view this document in its entirety, download the Adobe Acrobat graphic file available from this Web site or order a print copy from NCJRS at 800-638-8736. Sexually Transmitted Diseases and Child Sexual Abuse Portable Guides to Investigating Child Abuse - Foreword Investigating allegations of sexual abuse of children is very difficult for law enforcement. Successful resolution of these cases is often hampered by victim reluctance or inability to communicate as well as the scarcity of corroborating evidence. While the consequences of all abuse of children are of great concern to us, sexual abuse can be particularly devastating, especially when a sexually transmitted disease is part of the tragic legacy of violation. This guide is designed to present additional investigative techniques, utilizing the presence of a sexually transmitted disease, which will assist in identifying or eliminating suspects in sexual abuse cases. Successful investigations are crucial because they can be the gateway to treatment for victims and can help protect them from further victimization. The guide also seeks to sensitize investigators to the need for personal precautions when investigating these cases and helps them to recognize children in need of immediate medical attention. OJJDP is proud of this offering and urges you to make use of it as we work to protect our children. Original Printing June 1996 Second Printing July 1997 Third Printing March 2001 NCJ 160940 - Sexually transmitted diseases (STD's) comprise a wide range of infections and conditions that are transmitted mainly by sexual activity. The classic STD's, gonorrhea and syphilis, are now being overshadowed by a new set of STD's that are not only more common, but are also more difficult to diagnose and treat. These new STD's include infections caused by Chlamydia trachomatis (chlamydia), human papilloma virus (HPV), bacterial vaginosis (BV), and human immunodeficiency virus (HIV). Rapid application of new technology to the diagnosis of STD's has led to a growing array of diagnostic laboratory tests that require critical evaluation by clinicians and a critical review by law enforcement. Accurate information about STD's in victims of sexual abuse has been hindered by a variety of factors: o The prevalence of sexually transmitted infections may vary regionally and among different populations within the same region. o Few studies have attempted to differentiate between infections existing prior to sexual abuse and those that result from abuse. The presence of a preexisting infection in adults is usually related to prior sexual activity. In children, however, preexisting infections may be related to prolonged colonization after perinatal acquisition (acquisition immediately before and after birth), inadvertent nonsexual spread, prior peer sexual activity, or prior sexual abuse. o The incubation periods for STD's range from a few days for gonorrhea to several months for HPV. The incubation periods and the timing of an examination after an episode of abuse are critically important in detecting infections. When presented with a child with an STD, law enforcement officials must attempt to determine absolutely if the infection was associated with sexual contact and, for the purposes of prosecution, whether appropriate diagnostic methods were used. The following facts should be kept in mind: o STD's may be transmitted during sexual assault. o Multiple episodes of abuse increase the risk of STD infection, probably by increasing the number of contacts with an infected individual, and rates of infection also vary by the type of assault. For example, vaginal or rectal penetration is more likely to lead to detectable STD infection than fondling. o Sexual assault is a violent crime that affects children of all ages, including infants. o The majority of children who are sexually abused will have no physical complaints related either to trauma or STD infection. Most sexually abused children do not indicate that they have genital pain or problems. o In children the isolation of a sexually transmitted organism may be the first indication that abuse has occurred. o In most cases, the site of infection is consistent with a child's history of assault. o Although the presence of a sexually transmissible agent in a child over the age of 1 month is suggestive of sexual abuse, exceptions do exist. Rectal and genital chlamydia infections in young children may be due to a persistent perinatally acquired infection, which may last for up to 3 years. The incidence and prevalence of sexual abuse in children are difficult to estimate. o Most sexual abuse in childhood escapes detection. o Patterns of childhood sexual abuse appear to depend on the sex and age of the victim. o Between 80 and 90 percent of sexually abused children are female (average age: 7 to 8 years). o Between 75 and 85 percent of sexually abused children were abused by a male assailant, an adult or minor known to the child. This individual is most likely a family member such as the father, stepfather, mother's boyfriend, or an uncle or other male relative. o Victims of unknown assailants tend to be older than children who are sexually abused by someone they know and are usually only subjected to a single episode of abuse. o Sexual abuse by family members or acquaintances usually involves multiple episodes over periods ranging from 1 week to years. o Most victims describe a single type of sexual activity, but over 20 percent have experienced more than one type of forced sexual act. Vaginal penetration has been reported to occur in approximately one-half and anal penetration in one-third of female victims of sexual abuse. o Over 50 percent of male victims of sexual abuse have experienced anal penetration. o Other types of sexual activity, including oral-genital contact and fondling, occur in 20 to 50 percent of victims of sexual abuse. o Children who are sexually abused by known assailants usually experience less physical trauma, including genital trauma, than victims of assaults by strangers because such trauma might arouse suspicion that abuse is occurring. Author Margaret R. Hammerschlag, M.D. Professor of Pediatrics and Medicine Division of Pediatric Infectious Diseases State University of New York Health Science Center at Brooklyn 450 Clarkson Avenue, Box 49 Brooklyn, NY 11203-2098 718-245-4074 - Supplemental Reading Centers for Disease Control and Prevention. 1993 sexually transmitted diseases treatment guidelines. Morbidity and Mortality Weekly Report 42:RR-14, 1993. Child Sexual Abuse: Report of the Twenty-Second Ross Roundtable on Critical Approaches to Common Pediatric Problems in Collaboration With the Ambulatory Pediatric Association. Ross Laboratories, 1991. Evidence Collection Protocol. Texas Department of Health, Bureau of Emergency Management, Sexual Assault Prevention and Crisis Services Program, 1990. Hammerschlag MR. Sexually transmitted diseases in sexually abused children. Advances in Pediatric Infectious Diseases 3:1-18, 1988. Hammerschlag MR, Doraiswamy B, Alexander ER, et al. Are rectogenital chlamydial infections a marker of sexual abuse in children? Pediatric Infectious Disease Journal 3:100-104, 1984. Hammerschlag MR, Retting PJ, Shields ME. False positive results with the use of chlamydial antigen detection tests in the evaluation of suspected sexual abuse in children. Pediatric Infectious Disease Journal 7:11-14, 1988. Jenny C, Hooton TM, Bowers A, et al. Sexually transmitted diseases in victims of rape. New England Journal of Medicine 322:713-716, 1990. Sexual Assault: A Hospital/Community Protocol for Forensic and Medical Examination. U.S. Department of Justice, Office of Justice Programs, Office for Victims of Crime, 1985. Understanding the Medical Diagnosis of Child Maltreatment: A Guide for Non-Medical Professionals. The American Humane Association, American Association for Protection of Children, 1989. Whitcomb D. When the Victim Is a Child. 2d ed. U.S. Department of Justice, National Institute of Justice, 1992. Whittington WL, Rice RJ, Biddle JW, et al. Incorrect identification of Neisseria gonorrhoeae from infants and children. Pediatric Infectious Disease Journal 7:3-10, 1988. - Organizations Missing and Exploited Children's Training Programs Fox Valley Technical College Criminal Justice Department P.O. Box 2277 1825 North Bluemound Drive Appleton, WI 54914-2277 800-648-4966 920-735-4757 (fax) http://www.foxvalley.tec.wi.us/ojjdp Participants are trained in child abuse and exploitation investigative techniques, covering the following areas: o Recognition of signs of abuse. o Collection and preservation of evidence. o Preparation of cases for prosecution. o Techniques for interviewing victims and offenders. o Liability issues. Fox Valley also offers an intensive special training for local child investigative teams. Teams must include representatives from law enforcement, prosecution, social services, and (optionally) the medical field. National Children's Alliance 1612 K Street NW., Suite 500 Washington, DC 20006 800-239-9950 202-639-0597 202-639-0511 (fax) http://www.nca-online.org Children's Advocacy Centers (CAC's) are community-based programs that bring together representatives from law enforcement, child protective services, prosecution, mental health, and the medical community in multidisciplinary teams to address the investigation, treatment, and prosecution of child abuse cases. The National Children's Alliance (NCA), formerly the National Network of Children's Advocacy Centers, provides leadership and advocacy for these programs on a national level, including training and publications. The following four Regional Children's Advocacy Centers work jointly with NCA, providing information, consultation, and training and technical assistance to help communities establish child-focused programs that facilitate and support coordination among agencies responding to child abuse. o Midwest Regional Children's Advocacy Center, Midwest Children's Resource Center, St. Paul, Minnesota, 888-422-2955. o Southern Regional Children's Advocacy Center, Rainbow City, Alabama, 800-747-8122. o Northeast Regional Children's Advocacy Center, Philadelphia Children's Alliance, Philadelphia, Pennsylvania, 800-662-4124. o Western Regional Children's Advocacy Center, Lakewood, Colorado, 800-582-2203. Sexual Assault Nurse Examiners (SANE) Program 600 Civic Center Tulsa, OK 74103 918-596-7608 Other Titles in This Series Currently there are 12 other Portable Guides to Investigating Child Abuse. Additional guides in this series may be developed at a later date. To obtain a copy of any of the guides listed below (in order of publication), contact the Office of Juvenile Justice and Delinquency Prevention's Juvenile Justice Clearinghouse by telephone at 800-638-8736 or e-mail at puborder@ncjrs.org. Recognizing When a Child's Injury or Illness Is Caused by Abuse, NCJ 160938 Photodocumentation in the Investigation of Child Abuse, NCJ 160939 Diagnostic Imaging of Child Abuse, NCJ 161235 Battered Child Syndrome: Investigating Physical Abuse and Homicide, NCJ 161406 Interviewing Child Witnesses and Victims of Sexual Abuse, NCJ 161623 Child Neglect and Munchausen Syndrome by Proxy, NCJ 161841 Criminal Investigation of Child Sexual Abuse, NCJ 162426 Burn Injuries in Child Abuse, NCJ 162424 Law Enforcement Response to Child Abuse, NCJ 162425 Understanding and Investigating Child Sexual Exploitation, NCJ 162427 Forming a Multidisciplinary Team To Investigate Child Abuse, NCJ 170020 Use of Computers in the Sexual Exploitation of Children, NCJ 170021 Additional Resources American Bar Association (ABA) Center on Children and the Law Washington, DC 202-662-1720 202-662-1755 (fax) American Humane Association Englewood, Colorado 800-227-4645 303-792-9900 303-792-5333 (fax) American Medical Association (AMA) Department of Mental Health Chicago, Illinois 312-464-5000 (AMA main number) 312-464-4184 (fax) American Professional Society on the Abuse of Children (APSAC) Oklahoma City, Oklahoma 405-271-8202 405-271-2931 (fax) Federal Bureau of Investigation (FBI) National Center for the Analysis of Violent Crime Quantico, Virginia 703-632-4333 Fox Valley Technical College Criminal Justice Department Appleton, Wisconsin 800-648-4966 920-735-4757 (fax) Juvenile Justice Clearinghouse (JJC) Rockville, Maryland 800-638-8736 301-519-5600 (fax) Kempe Children's Center Denver, Colorado 303-864-5252 303-864-5302 (fax) National Association of Medical Examiners St. Louis, Missouri 314-577-8298 314-268-5124 (fax) National Center for Missing and Exploited Children (NCMEC) Alexandria, Virginia 703-274-3900 703-274-2220 (fax) National Center for the Prosecution of Child Abuse Alexandria, Virginia 703-549-4253 703-549-6259 (fax) National Children's Alliance Washington, DC 800-239-9950 202-639-0597 202-639-0511 (fax) National Clearinghouse on Child Abuse and Neglect Information Washington, DC 800-FYI-3366 703-385-7565 703-385-3206 (fax) National SIDS Resource Center Vienna, Virginia 703-821-8955, ext. 249 703-821-2098 (fax) Prevent Child Abuse America Chicago, Illinois 800-835-2671 312-663-3520 312-939-8962 (fax) - U.S. Department of Justice Office of Justice Programs Office of Juvenile Justice and Delinquency Prevention Washington, DC 20531 | |
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