Genital herpes in children under 11 years and investigations for sexual abuse

Abstract

Genital herpes in children under 11 years is rare. Almost a third of children diagnosed with genital herpes did not have appropriate virological investigation and few were screened for other STIs. Around a quarter of cases were referred to child protection agencies for further investigation, which limits any inferences in this study about mode of transmission in children. Sexual abuse guidance should emphasise the need for thorough assessment and investigation in cases of genital herpes in children.

Caso de abuso sexual e infección por virus herpes tipo 2 en Atención Primaria

“…Las ITS de origen viral están descritas como 1,5 veces más frecuentes que las bacterianas 5 . La aparición de infecciones por el virus del papiloma humano (VPH) o por el VHS en niños -sobre todo en menores de 11 años-siempre deben hacernos sospechar un abuso sexual, aunque en muchos de los casos no se puede confirmar 6 . Varios estudios insisten en la necesidad de hacer un cribado correcto para la detección de ITS, ya sean virales o bacterianas; incluso se habla de la importancia de realizar segundas evaluaciones, poniendo especial énfasis en que deben ser realizadas por expertos 6,7 .…”

“…La aparición de infecciones por el virus del papiloma humano (VPH) o por el VHS en niños -sobre todo en menores de 11 años-siempre deben hacernos sospechar un abuso sexual, aunque en muchos de los casos no se puede confirmar 6 . Varios estudios insisten en la necesidad de hacer un cribado correcto para la detección de ITS, ya sean virales o bacterianas; incluso se habla de la importancia de realizar segundas evaluaciones, poniendo especial énfasis en que deben ser realizadas por expertos 6,7 . El VHS-2 infecta fundamentalmente e144 los genitales, siendo frecuentes las recurrencias (como ocurrió en nuestro caso) hasta que consigan mantener un nivel estable de anticuerpos, siendo posible difundir el virus mientras se es portador 8 .…”

Assessment for sexual abuse in a case presenting with genital herpes

“…Genital herpes in children under the age of 11 is rarely seen, with a rate of about 1/1000000. In one-third of these cases, no viral investigation was established, and in a very small fraction, other sexually transmitted diseases were found (13). While in adults, sexual transmission is common, it has been reported that in cases below the age of 5, anogenital herpes can be contracted by nonsexual routes.…”

“…In the existing literature, it has been reported that in examinations of children with herpetic lesions in England, HSV-1 was found to be more common than HSV-2 (14), which also indicates that non-sexual infection is more common (13). When encountering genital herpes, it is important to carry out HSV serotyping.…”

“…In the literature, there is little information about the serotypes of genital herpes. In a presentation assessing 16 individuals with genital herpes, in 13 cases HSV-1 was found, in one case both HSV-1 and HSV-2, in one person HSV-2, and in one case viral cytopathology was not done (13). Non-sexual transmission paths reported for genital herpes include autoinoculation, finger contact by an adult changing nappies leading to infection, hand contact between children, or transmission via infected objects (plate, fork, garments, etc.)…”