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
✹ 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
✹ 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,
✹ 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.
✹ 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
✹ 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
✹ Over 50 percent of male victims of sexual abuse have experienced
✹ 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.