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成人、青少年和儿童中的性侵犯和性传播感染。

Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children.

机构信息

Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill.

Division of STD Prevention, Bureau of Infectious Diseases, Massachusetts Department of Public Health, Jamaica Plain.

出版信息

Clin Infect Dis. 2015 Dec 15;61 Suppl 8:S856-64. doi: 10.1093/cid/civ786.

Abstract

Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.

摘要

性侵犯幸存者有感染性传播感染(STI)的风险。我们进行了文献回顾,并邀请专家协助更新 2015 年疾病控制与预防中心性传播疾病(STD)治疗指南中的性侵犯部分。针对成人和青少年性侵犯幸存者的新 STI 管理建议包括:使用阴道拭子的核酸扩增试验(NAAT)检测阴道毛滴虫;对有性侵犯暴露史或疑似性侵犯后外生殖器接触史的患者,使用咽和直肠标本进行淋病奈瑟菌和沙眼衣原体的 NAAT 检测;根据更新的治疗方案,对淋病、衣原体和滴虫病进行经验性治疗;为年龄在 9-26 岁之间的既往未接种过疫苗的患者接种人乳头瘤病毒(HPV)疫苗;根据评估暴露时间和特征的算法,考虑对人类免疫缺陷病毒(HIV)进行非职业性暴露后预防。对于儿童性侵犯(CSA)幸存者,建议包括:适当增加使用 NAAT 进行有针对性的诊断检测;在最后一次已知性虐待后 6 个月内进行常规随访;根据国家免疫接种指南,在性侵犯后护理环境中使用 HPV 疫苗作为预防措施。对于 CSA 患者,NAAT 被认为可用于从尿液样本中识别淋病奈瑟菌和衣原体感染,但不推荐用于外生殖器检测,因为可能会检测到非淋病奈瑟菌物种。针对成人、青少年和儿科性侵犯幸存者的 STI/HIV 感染的流行率、检测和管理,确定了几个研究问题。

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