Risk markers:
(1) presence of a genital discharge by recent history or on physical examination
(2) perpetrator is suspected of having a sexually transmitted disease
(3) suspicious anal and/or genital findings
(4) disclosure of sexual contact or penetration (genital-to-genital; genital-to-rectal; genital-to-oral)
(5) disclosure of genital fondling
(6) exhibits obvious sexual play during the evaluation
(7) sexual abuse of a sibling
(8) vaginitis if female
These markers are divided into major and minor risk factors, which may vary on the type of testing being considered.
|
Testing
|
Major Risk Factors
|
Minor Risk Factors
|
|
GC and chlamydia
|
1, 2, 3, 4
|
7, 8
|
|
GC only
|
1, 2, 3
|
4, 5, 6, 7, 8
|
Indications for performing GC and chlamydia testing - one or both of the following:
(1) >= 1 major risk factor
(2) >= 2 minor risk factors
Indications for performing GC testing only - one or both of the following:
(1) >= 1 major risk factor
(2) >= 3 minor risk factors
Performance:
• Both strategies for testing had a sensitivity of 100%.
• The specificity for GC and chlamdyia protocol was 56%. The specificity for the GC only protocol was 69%.
Considerations in screening (not from reference):
(1) possible additional exposures (HIV, Herpes simplex, syphilis, viral hepatitis, etc.)
(2) sites for specimen collection (oral, genital, rectal)
(3) cost of screening
(4) type of followup
(5) screening of perpetrator (if in custody)
(6) use of a barrier during the sexual assault
