GONCA ÖZYURT, Baris GULLER, Burak BAYKARA, Özlem GENÇER, AYLİN ÖZBEK

Genital herpetik veziküllerle başvuran bir olgunun cinsel istismar yönünden değerlendirmesi

Çocuk cinsel istismarı; çocuğun bir yetişkin veya yaşça büyük bir kişi tarafından cinsel uyarı amacıyla kullanılması olarak tanımlanmaktadır. Aile içi cinsel ilişkinin (ensest) "özellikle de çocuğa yönelik olanın" tüm inanç sistemlerinde ve toplumlarda yasaklanmış olması nedeniyle çocuğun cinsel istismarı, istismarlar içerisinde en zor saptanabilendir. Genital herpes, prepubertal dönemde cinsel istismar bulgusu olabileceğinden mutlaka değerlendirilmesi gereken bir durumdur. Yetişkinlerde cinsel yolla bulaş fazla olmasına rağmen özellikle 5 yaşın altındaki olgularda anogenital herpesin cinsel olmayan yolla da bulaşabildiği bildirilmektedir. Genital herpesin olası cinsel olmayan bulaş yolları; otoinokulasyon, alt bezleme sırasında bakım veren erişkinden parmak teması ile bulaş, çocukların birbirine elle teması, enfekte nesnelerle bulaş (tabak, çatal, elbise vb.) olarak bildirilmektedir. Cinsel istismarı değerlendirmede yardımcı olan kılavuzlar, pediyatrik genital herpes olgularının cinsel istismar yönünden nasıl ele alınması gerektiği konusunda yetersiz kalmaktadır. Bu konuda daha fazla kanıta gereksinim vardır. Bu sunumda anogenital herpes nedeniyle acil servise başvuran 2 yaş 3 aylık bir kız olguda cinsel istismar açısından değerlendirilme süreci sunulmuştur

Assessment for Sexual Abuse in A Case Presenting with Genital Herpes

Child sexual abuse is defined as the use of a child by an adult or a significantly older person for the purpose of sexual stimulation. Sexual relations within the family (incest) “particularly involving children” is prohibited in all faiths and societies; hence, incestuous child sexual abuse is the form of abuse most difficult to determine. Prepubertal genital herpes is a presentation that definitely needs to be assessed as a potential indication for sexual abuse. Even though in adults transmission is often by sexual route, it has been pointed out that especially in cases below the age of 5 years, anogenital herpes can be transmitted by non-sexual mechanisms. As paths for a possible non-sexual transmission of genital herpes, autoinoculation, finger contact by an adult changing nappies leading to infection, hand contact between children, or transmission via infected objects (plate, fork, garments, etc.) have been reported. Guidelines helping in the assessment of sexual abuse are insufficient regarding the question how the issue should be confronted in pediatric cases of genital herpes. More evidence is required to solve this problem. In our presentation, we discuss the process of assessment for sexual abuse in the case of a girl aged 2 years 3 months presenting to the emergency department with anogenital herpes

PDF

___

1. Walker JL, Carey PD, Mohr N, Stein DJ, Seedat S. Gender differences in the prevalence of childhood sexual abuse and in the development of pediatric PTSD. Arch Womens Ment Health 2004; 7:111-121. [CrossRef]
2. Golge BG. Psychological problems occurring after sexual trauma. Archives of Neuropsychiatry 2005; 42;19-28. (Turkish)
3. Bozbeyoglu AC, Koyuncu E, Sezgin AU, Kardam F, Sungur A. Understanding the problem of incest in Turkey. Association for Demography and United Nations Population Fund (UNFPA). Damla Publishing, Ankara, 2009. (Turkish)
4. Gencer O, Guvenir T. Sexual Abuse in Child and Adolescent: In Acar B (editor). Pediatric and Adolescent Gynecology. Istanbul Medikal Yayincilik, Izmir, 2010: 32;pp. 351-359. (Turkish)
5. Bromberg K, Hammerschlag M, Rawstron SA, Bilo RAC, Oranje AP. Sexually Transmitted Disease in Children and Adolescents. In: Harper J, Orange A, Prose N. Textbook of Pediatric Dermatology. First ed. Oxford: Blackwell Sci 2002: 1510-1529.
6. Todd G, Krause W. Sexually Transmitted Diseases. In: Schachner LA, Hansen RC, (editors). Pediatric Dermatology. Third ed, Edinburgh: Mosby 2003: 1181-1223.
7. Adelson ME, Feola M, Trama J, Tilton RC, Mordechai E. Simultaneous detection of herpes simplex virus types 1 and 2 by real-time PCR and Pyrosequencing. J Clin Virol 2005; 33:25-34. [CrossRef]
8. Savasir I, Sezgin N, Erol N. Handbook for the Ankara Developmental Screening Inventory, 1st edition. Rekmay, Ankara, 1994a. (Turkish)
9. Yalaz K, Anlar B, Bayoglu B. Denver II Developmental Screening Test, “Standardization for Turkey”. Association for Developmental Child Neurology, Ankara, 2011. (Turkish)
10. Patel R, Barton SE, Brown D, Cowan FM, Kinghorn GR, Munday PE, Scoular A, Timmins D, Whittaker M, Woolley P; Herpes Simplex Virus Special Interest Group of the Medical Society for the Study of Venereal Diseases, United Kingdom; European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization. European guideline for the management of genital herpes. Int J STD AIDS 2001; 12(Suppl.3):34-39. [CrossRef]
11. Serdaroglu S. Practical Approaches to Community-Acquired Infections: Symposium Series 2008. Istanbul University Cerrahpasa Faculty of Medicine, Symposium Series Publication No:61, Istanbul, 183-200. (Turkish)
12. Taneli S, Albayrak EC, Sivrioglu EY. I Am Not Ill: Eksi A (editor). Psychosocial Aspect of Pediatrics. Nobel Tip Kitabevleri, Istanbul, 1999; 531-541. (Turkish)
13. Reading R, Hughes G, Hill J, Debelle G. Genital herpes in children under 11 years and investigations for sexual abuse. Arch Dis Child 2011; 96:752-757. [CrossRef]
14. Scoular A. Using the evidence base on genital herpes: optimising the use of diagnostic tests and information provision. Sex Transm Infect 2002; 78:160-165. [CrossRef]
15. Reading R, Rannan-Eliya Y. Evidence for sexual transmission of genital herpes in children. Arch Dis Child 2007; 92:608-613. [CrossRef]