Hammerschlag M R
Department of Pediatrics, SUNY Health Science Center at Brooklyn 11203-2098, USA.
Sex Transm Infect. 1998 Jun;74(3):167-74. doi: 10.1136/sti.74.3.167.
Sexually transmitted diseases (STDs) may be transmitted during sexual assault. In children, the isolation of a sexually transmitted organism may be the first indication that abuse has occurred. Although the presence of a sexually transmissible agent from a child beyond the neonatal period is suggestive of sexual abuse, exceptions do exist. In this review I discuss the issues of the transmissibility and diagnosis of STDs in the context of child sexual abuse. Rectal or genital infection with Chlamydia trachomatis among young children may be the result of perinatally acquired infection and may persist for as long as 3 years. A major problem with chlamydia testing in the context of suspected sexual abuse in children has been the inappropriate use of non-culture tests. Although the new generation of nucleic acid amplification tests have shown high sensitivity and specificity with genital specimens from adults, data on use of these tests on any site in children are practically non-existent. Bacterial vaginosis (BV) has been identified among children who have been abused and among those who have not been abused. However, many of the methods used to diagnose BV in adults have not been evaluated in children. Recent studies of perinatal infection with human papillomavirus (HPV) have been inconclusive. HPV DNA has been detected at various sites in children who have not been abused. The relation to the development of clinically apparent genital warts is unclear. Although HIV can be acquired through sexual abuse in children, the exact risk to the child and which children should be screened is still controversial.
性传播疾病（STDs）可能在性侵犯过程中传播。对于儿童而言，性传播病原体的检出可能是虐待行为发生的首个迹象。虽然新生儿期后的儿童体内存在性传播病原体提示可能遭受性虐待，但也存在例外情况。在本综述中，我将在儿童性虐待的背景下讨论性传播疾病的传播及诊断问题。幼儿沙眼衣原体的直肠或生殖器感染可能是围产期获得性感染的结果，且可能持续长达3年。在疑似儿童性虐待的情况下，衣原体检测的一个主要问题是不恰当使用非培养检测方法。尽管新一代核酸扩增检测方法对成人生殖器标本显示出高灵敏度和特异性，但几乎没有关于在儿童任何部位使用这些检测方法的数据。细菌性阴道病（BV）在遭受虐待和未遭受虐待的儿童中均有发现。然而，许多用于诊断成人性细菌性阴道病的方法尚未在儿童中进行评估。近期关于人乳头瘤病毒（HPV）围产期感染的研究尚无定论。在未遭受虐待的儿童的不同部位检测到了HPV DNA。其与临床明显的尖锐湿疣发展之间的关系尚不清楚。虽然儿童可通过性虐待感染HIV，但儿童的确切风险以及哪些儿童应接受筛查仍存在争议。
