Abuse, Sexual, Suspected — Indications for STI Testing — Clinical Pathway: Emergency Department

Sexual Abuse Clinical Pathway — Emergency Department

Indications for STI Testing

Prepubertal
  • History of penetration
  • Child unable to provide details of event
  • Acute genital, anal, or oropharyngeal injury
  • Injury to the genitals, anus, or oropharynx
  • Assault by stranger
  • Known perpetrator with STI, high risk for STI
  • Genital symptoms (e.g., discharge, pain) concerning for STI
  • Genital lesions (e.g., vesicles, warts) concerning for STI
  • Family request for STI testing
  • Sibling, other person in household with STI
Postpubertal Indicated for all after obtaining consent

Reference: Sexual Assault or Abuse of Children  

STI Testing

  • When testing is indicated, obtain all of the following
  • Collect specimen from any site of possible, attempted, or confirmed penetration
Molecular Amplification Testing for GC, Chlamydia Trichomonas
  • Urine, Female and Male
    • Non-clean catch or ‘dirty’ urine sample, first 30 mL of urinary stream
    • Aptima Urine Collection Kit
      • Ensure volume is within the fill lines to avoid specimen rejection
  • Pharyngeal, Rectal, Vaginal Swabs, Female and Male
    • Use blue shaft Aptima Unisex Swab from the kit
    • Swab for 10 secs
  • Note: Vaginal swab is not necessary, but can be used if unable to obtain urine
HIV
RPR
  • Syphilis cases increasing in Philadelphia
  • Send FTA-ABS to confirm infection if RPR positive

Additional STI Testing

History and clinical exam guides the need for additional testing.

Consider expanded STI Testing for the following due to increased risk:

  • IV drug use
  • Incarceration
  • Concern for sex trafficking
  • Unreliable tattoo administration
Hepatitis B
  • Unimmunized or not fully immunized
  • Hepatitis B surface antigen
Hepatitis C
  • As clinically indicated
  • Hepatitis C quantitative RNA
HSV Unroof lesion, swab, and place in viral transport media