HOLLIE GREIG AND THE STD

Accurate information about STD’s in victims of sexual abuse

has been hindered by a variety of factors:


The prevalence of sexually transmitted infections may vary


regionally and among different populations within the same

region.


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.


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 (see table 1).



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:


STD’s may be transmitted during sexual assault.

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.


Sexual assault is a violent crime that affects children of all ages,


including infants.


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.


In children the isolation of a sexually transmitted organism may


be the first indication that abuse has occurred.


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In most cases, the site of infection is consistent with a child’s


history of assault.


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.


Most sexual abuse in childhood escapes detection.

Patterns of childhood sexual abuse appear to depend on the sex


and age of the victim.


Between 80 and 90 percent of sexually abused children are female


(average age: 7 to 8 years).


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.


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.


Sexual abuse by family members or acquaintances usually


involves multiple episodes over periods ranging from 1 week

to years.


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.


Over 50 percent of male victims of sexual abuse have experienced


anal penetration.


Other types of sexual activity, including oral-genital contact and


fondling, occur in 20 to 50 percent of victims of sexual abuse.


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.

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