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Anogenital HSV in Children: Should Providers Be Concerned for Sexual Abuse?

  • Abigail Keogh
    Correspondence
    Address correspondence to: Abigail Keogh, MD, 71 Parkman St, Apt 3, Brookline MA 02446, Telephone: 434-566-3668
    Affiliations
    Department of Pediatrics, Division of Child Abuse Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
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  • Amy Goldberg
    Affiliations
    Department of Pediatrics, Division of Child Abuse Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
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  • Christian Schroeder
    Affiliations
    Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
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  • Brett Slingsby
    Affiliations
    Department of Pediatrics, Division of Child Abuse Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI
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  • Author Footnotes
    # Contributed equally as co-senior authors.
    Erica Hardy
    Footnotes
    # Contributed equally as co-senior authors.
    Affiliations
    Department of Medicine, Divisions of Obstetric Medicine and Infectious Disease, Warren Alpert Medical School of Brown University, Providence, RI
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  • Author Footnotes
    # Contributed equally as co-senior authors.
    Ian Michelow
    Footnotes
    # Contributed equally as co-senior authors.
    Affiliations
    Department of Pediatrics, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI
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  • Author Footnotes
    # Contributed equally as co-senior authors.
Published:January 21, 2023DOI:https://doi.org/10.1016/j.jpag.2023.01.004

      Abstract

      Objective

      Anogenital herpes simplex virus (HSV) is most commonly acquired via sexual transmission although other nonsexual modes of transmission have been proposed. When a child presents with a first-time outbreak of anogenital HSV, providers must consider sexual abuse. There are currently no evidence-based consensus guidelines to inform management of these patients. The purpose of this study is to describe how child abuse pediatricians (CAP) evaluate children with anogenital HSV infection and determine whether any consistent practice patterns are followed.

      Participants and setting

      Patients included in this study were children between the ages of 0 and 12 years with a first-time outbreak of anogenital HSV who were medically evaluated by a CAP.

      Methods

      Patient charts were retroactively reviewed for the period of January 1, 2004 and May 1, 2020.

      Results

      Twenty-two cases were referred for evaluation by CAP in the chosen time frame. Fifteen were seen in person. Ten of these patients were interviewed, 15 had an anogenital exam with colposcopy, and 14 were tested for at least one other sexually transmitted infection. A diagnosis of sexual abuse was made for 1 patient.

      Conclusions

      This study demonstrates that while non-sexual transmission of anogenital HSV may be possible, providers must still consider sexual abuse. Children with a first-time outbreak of anogenital HSV should have a comprehensive evaluation for sexual abuse including interview, physical exam, and testing for sexually transmitted infections. Evidence-based concerns for sexual abuse should be reported to child protective services.

      Keywords

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