title: Genital herpes in children under 11 years and investigations for sexual abuse.
abstract: OBJECTIVE
  The implications for sexual abuse investigation of genital herpes in a child are uncertain because of a lack of good quality research evidence. The incidence, presenting features, history of exposure, indicators of child maltreatment and outcomes of child protection investigations in children with genital herpes are described.
  
  
  METHODS
  Ascertainment of all cases of genital herpes in children <11 years of age first presenting to paediatricians in the UK and Ireland from April 2007 to April 2009 conducted through the British Paediatric Surveillance Unit.
  
  
  RESULTS
  23 cases were notified. The incidence of confirmed and all reported cases was 0.091 and 0.13 per 100,000 children per year, respectively. Of the 16 virologically confirmed cases, 12 were female, 11 were <5 years of age, 14 had herpes simplex type 1, eight were tested for other sexually transmitted infections (STIs), and only one had a full STI screen. Three cases had other clinical features suggestive of sexual abuse. Six cases were referred for child protection investigation, but no sexual abuse was substantiated.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. richard.reading@nnuh.nhs.uk
authors.forename: Richard
authors.initials: R
authors.lastname: Reading
authors.forename: Gwenda
authors.initials: G
authors.lastname: Hughes
authors.forename: Julia
authors.initials: J
authors.lastname: Hill
authors.forename: Geoff
authors.initials: G
authors.lastname: Debelle
mesh_terms: D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000706:statistics & numerical data; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006558:Herpes Genitalis / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007223:Infant; D007494:Ireland / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology