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74 MMWR May 10, 2002
If caregivers choose for the child to receive antiretroviral
postexposure prophylaxis (29,114), provide enough
medication until the return visit at 3–7 days after initial
assessment to reevaluate child and to assess tolerance of
medication; dosages should not exceed those for adults.
Perform HIV antibody test at original assessment, 6 weeks,
3 months, and 6 months.
Examination 12 Weeks After Assault
In circumstances in which transmission of syphilis, HIV, or
hepatitis B is a concern but baseline tests are negative, an
examination approximately 12 weeks after the last suspected
sexual exposure is recommended to allow time for antibodies
to infectious agents to develop. The prevalence of these infections
differs substantially by community. In addition, results
of HBsAg testing must be interpreted carefully, because HBV
can be transmitted non-sexually. Decisions regarding which
tests should be performed must be made on an individual basis.
Presumptive Treatment
The risk of a child acquiring an STD as a result of sexual
abuse or assault has not been determined. Presumptive treatment
for children who have been sexually assaulted or abused
is not recommended because a) the prevalence of most STDs
is low following abuse/assault, b) pre-pubertal girls appear to
be at lower risk for ascending infection than adolescent or
adult women, and c) regular follow-up of children usually can
be ensured. However, some children or their parent(s) or
guardian(s) may be concerned about the possibility of infection
with an STD, even if the risk is perceived to be low by the
health-care provider. Such concerns may be an appropriate
indication for presumptive treatment in some settings and may
be considered after all specimens for diagnostic tests relevant
to the investigation have been collected.
Reporting
Every state and U.S. territory has laws that require the
reporting of child abuse. Although the exact requirements differ
by state, if a health-care provider has reasonable cause to suspect
child abuse, a report must be made. Health-care providers
should contact their state or local child-protection service
agency about child-abuse reporting requirements in their areas.
References
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