Question 9 - Sexual Assault and Abuse and STIs Question Bank

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Sexual Assault and Abuse and STIsQuestion 9/10

A 4-year-old girl is brought to the pediatrician for a painless vulvar rash noticed one day ago by her mother when bathing her daughter. The child has no other rashes or oral lesions. On physical examination, the medical provider observes a painless, shallow ulcer in the vulvar region. Furthermore, several features in the history and evaluation cause the medical provider to consider sexual abuse. Laboratory testing shows a negative polymerase chain reaction (PCR) for herpes simplex virus, a positive syphilis IgG, and a positive Rapid Plasma Reagin (RPR) with a 1:32 titer. All other laboratory tests, including tests for other sexually transmitted infections, are negative.

Which one of the following is the most plausible explanation for the findings in this child?

The vulvar lesion likely represents a delayed manifestation of congenital syphilis; the child should undergo a full work-up to evaluate for sequelae related to late congenital syphilis

The vulvar lesion likely represents primary syphilis contracted from a caregiver’s hands during a diaper change; all caregivers who have had contact with the child should be tested for syphilis

The syphilis laboratory test is likely a false-positive result; the vulvar lesion is more consistent with a diagnosis of Behçet's syndrome

The vulvar lesion likely represents primary syphilis contracted from sexual abuse, and this case should be reported to the state or local child protective services agency

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Question Last Updated
March 13th, 2025

Table 1.
Implications of Diagnosis of Sexually Transmitted Infections and Reporting in Prepubertal Children and Infants
Sexually Transmitted Infection	Sexual Abuse	Suggested Action
Chlamydia trachomatis	Diagnostic*	Report
Neisseria gonorrhoeae	Diagnostic*	Report
HIV	Diagnostic**	Report
Syphilis	Diagnostic*	Report
Trichomonas vaginalis	Highly suspicious	Report
Anogenital warts	Suspicious*	Report
Herpes simplex virus (genital location)	Suspicious^	Report
Bacterial vaginosis	Inconclusive	Medical follow-up
If not acquired perinatally and rare, nonsexual vertical transmission can be excluded. *If not acquired perinatally, through breastfeeding, or transfusion. ^Autoinoculation should be excluded. Adapted from: Kellogg N. The evaluation of sexual abuse in children. Pediatrics. 2005;116:506-12.

Source:

Kellogg N. The evaluation of sexual abuse in children. Pediatrics. 2005;116:506-12. [PubMed Abstract]

Chlamydial Infections

Gonococcal Infections

Syphilis

Genital Herpes

Human Papillomavirus Infection

Pelvic Inflammatory Disease

Vaginitis

Mpox

Mycoplasma genitalium

Chlamydial Infections

Gonococcal Infections

Syphilis

Genital Herpes

Human Papillomavirus Infection

Pelvic Inflammatory Disease

Vaginitis

Mpox

Mycoplasma genitalium

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Sexual Assault and Abuse and STIsQuestion 9/10

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Which one of the following is the most plausible explanation for the findings in this child?

Implications of Diagnosis of Sexually Transmitted Infections and Reporting in Prepubertal Children and Infants

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