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Most physical examinations in cases of sexual abuse or assault will be normal. Findings specific for acute trauma, although not necessarily diagnostic of sexual abuse or assault, include bruising, lacerations, and abrasions. Most of these injuries will heal quickly, usually within a few days, and will heal completely without scarring. Nonacute examination findings caused by trauma can be difficult to diagnose and should be interpreted by a qualified child abuse expert.
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Sexually transmitted infections diagnosed in a prepubertal child usually indicate sexual abuse. Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas, and syphilis are almost always transmitted by intimate sexual contact (intimate contact with infected secretions or lesions) unless acquired perinatally. HIV (unless acquired perinatally) and hepatitis are transmitted by intimate sexual contact or contact with infected blood. Condylomata acuminata (human papillomavirus or genital warts) and herpes simplex virus may be transmitted to the prepubertal child through sexual or nonsexual contact.
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Management and Disposition
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Victims of an acute sexual assault may have genital and/or anal bleeding. Patients who have active genital and/or anal bleeding need immediate attention and evaluation.
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Also see “Child Sexual Abuse Exam and Genital Findings.”
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