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. 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. 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. As a cumulative definition from the latest studies, incest is said to be any verbal or non-verbal, physical, or visual erotic behavior between family members except between the spouses. As in other parts of the world, in Turkey incest cases mostly remain hidden 3. Clinicians dealing with sexual abuse are confronted with presentations such as stomach ache, rectal bleeding, history of fall astride injury, chronic or recurrent urinary tract infection, as well as other somatic complaints, pregnancy, or behavioral problems. In addition, it is important to assess cases of bleeding or foreign body in vagina or rectum, condyloma acuminatum, genital herpes, trichomoniasis, gonococcal vulvovaginitis and other sexually transmissible diseases in children under the aspect of CSA. History received from the child always has to be the fundamental means of diagnosis 4. Genital herpes in children is very rare. It can present as an acute rash in the diaper region or with vulvar ulceration 5. The most common route of HSV transmission is perinatal through contact of the fetus with secretion from the mother carrying a genital infection. The increase of asymptomatic HSV-1 infection prevalence in the general population leads to a rise in infections of newborns via oropharyngeal route Given that genital herpes in the prepubertal period may constitute a sign of sexual abuse, it definitely requires assessment, but because of the increased HSV-1 infection prevalence, it needs to be pointed out carefully to the child and the parents, when being directed towards the child psychiatry unit, that there are Non Sexual Escort Service United States possible infection routes. In this paper, we describe the process of assessment for sexual abuse of a girl aged 2 years and 3 months admitted to emergency for anogenital herpes. During physical examination, herpetic blisters were found; for an assessment of sexual abuse, a consultation at the DEUFM Department of Child and Adolescent Pscyhiatry was requested. In the process, a consultation at the DEUFM Department of Dermatology was also requested, recommending Tzanck smear test to assess viral cytopathologic changes consistent with herpes, and typology by antibody assay. At the same time, psychiatric evaluation of the patient and her family was started. In the physical examination, apart from the herpetic blisters in the gluteal region, no results suggesting any kind of abuse had been found. Receiving the patient history, it was learned that the vesicular lesions had begun around two months earlier and increased over time. As to the family history, the parents were living together and did not identify any problems between them. The mother was a housewife aged 34, the father a year-old hauler; the patient had two siblings aged 5 and 7 years who did not have any adaptation problems. It was reported that they lived in a family condominium; the mother was looking after the patient, and in her absence, the paternal grandmother took care of the child. In the first assessment, serology of other sexually transmitted diseases was requested. Aerobic genital swab and aerobic stool culture produced normal flora bacteria. Her reaction to the separation from her parents was age-adequate and she spontaneously engaged in social relations. She responded to the alien environment age-adequately with explorative behavior and reacted to the separation from the parents according to her age. She established verbal relations by herself, and her language understanding and expression were adequate for her age. There were no abnormalities in speaking rate, fluency, rhythm, or intonation. Her hearing gave a normal impression. Affective responses were appropriate for the situation and conditions and quite rich. Her mood was mildly anxious, she was fully conscious and oriented, and during the event, her attention span was as expected for her age. There were no abnormalities in memory and perception, her intelligence gave an age-adequate impression, and her judgment and abstract thinking development levels were assessed Non Sexual Escort Service United States adequate. After psychiatric assessment, the patient did not show any other psychiatric symptom for sexual abuse, nor any indication for delay in development or physical signs; thus, it can be assumed that the herpetic lesions, with a positive serological result for HSV-1, were caused not by sexual infection but through non-sexual virus transmission from her mother.
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