INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

BACKGROUND

Cutaneous findings are the most common manifestations of abuse. Hence, a thorough dermatologic evaluation is crucial to rule out the possibility of injuries - accidental or intentional. Underreporting and incomplete documentation were also identified research gaps. The objectives of this study are to establish a baseline database, describe trends in the WCPU and ER medicolegal cases, and identify relationships among demographics, cutaneous findings, and injuries.

This is a case-control study conducted in a Tertiary Hospital in the Philippines. Medico-legal records from the emergency room and WCPU during 2019-2023 were retrieved and analyzed.

There were 2,611 WCPU Cases and 9511 ER Cases. Only 2,663 ER Cases (28%) have complete findings. The majority of the physically abused patients in the ER and WCPU perpetrators were adult males. Most WCPU patients were minor females. Only 25% of the WCPU cases were reported within three days. The majority of sexual perpetrators are not strangers to their victims. A significant fraction of sexual abuse is also incestuous. Several significant cutaneous findings suggestive of physical abuse were observed in this study. Intuitively, Gunshot wounds and stab wounds were associated with intentional injuries. Contusion and hematoma were more likely seen in cases of assaults involving accessible areas during altercations – the cheek, eye, eyelid, and nose. Injuries over protected body sites such as the chest and neck also warrant suspicion of intentional injuries. The abdomen, back, and chest were sites of predilection for both GSW and stab wounds.

It should be second nature for all physicians to identify dermatologic and demographic cues to rule out possible cases of abuse.

Child ; Humans ; East Asian People ; Quality of Life ; Students ; Child Abuse, Sexual ; Young Adult ; Resilience, Psychological

There has been a dramatic increase in very young adolescent pregnancies in recent years, with pregnancies documented in children as young as 10 years old, likely from sexual abuse. This article presents a 10-year-old female who initially consulted at the emergency room in her 27th week of pregnancy as a result of recurrent sexual abuse. Prompt assessment, diagnosis, and appropriate referrals to Obstetrics, Pediatric Adolescent Clinic, Psychiatry, and Child Protection Unit rendered optimal management for the patient. Dilemmas encountered in managing the case included preterm labor, large-for-gestational-age baby, immature pelvis, and approach to the appropriate mode of delivery compounded with management of trauma from sexual abuse. A multidisciplinary approach in managing these dilemmas achieved optimal outcomes with the patient delivering a live baby boy, appropriate for gestational age via cesarean section at term.
Child abuse ; pregnancy in adolescence ; preteen pregnancy ; teenage pregnancy ; sexual

Objectives: This paper presents the development of a local sexual assault investigation kit (SAK) that doctors in the Philippines could use to collect biological samples from victims of sexual abuse, including child patients, that would be used for DNA testing. The study also reports on a management system via courier service to protect the integrity of the samples that could be eventually used as evidence in court from the collection site to the laboratory with sufficient backup measures. Methods: Women and Child Protection Units (WCPU) from Manila, Baguio, Cebu, and Davao partnered with the DNA Analysis Laboratory, Natural Sciences Research Institute of UP Diliman (NSRI-UPD) DNA Analysis Laboratory in testing the utility of a prototype SAK for the collection of biological samples from child patients. From January 2002 to March 2006, samples were collected from patients who went to WCPU within 72 hours post-contact and consented to participate in the study. WCPU doctors collected biological samples guided by the patient’s narratives and packaged the samples while following detailed documentation and chain of custody procedures. SAKs were then sent via a designated courier service from WCPU to the NSRI-UPD DNA Analysis Laboratory for DNA testing. The WCPU kept half of the samples collected, following recommendations made during sectoral consultations that included members of the Research Group of the Philippine Judicial Academy, prosecutors, and defense counsels. Case samples were packed well by the WCPU and received at the NSRI-UPD DNA Analysis Laboratory. Due to budget limitations, only the internal genitalia and patients’ reference buccal swabs were subjected to DNA tests as reported by Maiquilla et al.1 The remaining SAK components and case records were kept in a dedicated and secure storage facility. DNA testing reports were sent to the WCPU, which released them to the child patients and their legal guardians. Results: One hundred fifty-four female children aged 2-18 years old and their legal guardians agreed to participate in the study. Based on the initial interviews of the social workers who conducted the evaluation, all the participants came from families with very low socioeconomic status. The WCPU doctors then complied with prescribed procedures. To date, NSRI-UPD DNA Analysis Laboratory records show that a subpoena for expert testimony had been issued in only one case out of the 63 cases (1.6%) that were positive for male DNA. No further information was available on the final decision in this case due to the absence of any order from the judge granting the laboratory access to court records. Likewise, WCPUs did not have any information on the remaining 62 cases that could have used the DNA test results as evidence if a case had been filed in court. Conclusion This study is the first to report the development and validation of a sexual assault investigation kit in the Philippines aimed at helping medical doctors in collecting and preserving critical biological samples for DNA testing. Using a dedicated courier service to send SAK from collecting agencies to the laboratory for DNA testing was successfully tested and resulted in faster delivery and significantly reduced overall cost. While DNA testing remains the most powerful tool for human identification and the technology has been available in the Philippines since 1997, certain factors have prevented it from being used routinely in sexual assault investigations, including those involving children.
Women and child protection units ; Sex Offenses

Objective: This study aimed to compare the clinical profile of prepubertal and pubertal female child sexual abuse. Methods: A cross-sectional analytical study involving 43 sexually abused children was done. Each patient was categorized as prepubertal or pubertal based on the Tanner stage. Medical history was gathered using a structured interview and physical examination done with proper documentation after obtaining consent. Blind review by child protection specialists was done on genital images. Descriptive statistics were utilized for all variables. Results: This study showed 11.97% and 22.22% prevalence for prepubertal and pubertal child sexual abuse, respectively. Most prepubertal children disclosed digital vaginal penetration by the father and non-relative household members, while most pubertal children reported penile-vaginal penetration by the boyfriend. Fondling was common to both groups. The majority were repeated abuse and usually happened at the perpetrator’s house. Behavioral changes and genital symptoms were common in prepubertal children. Findings of hymenal trauma were found in 25% of prepubertal girls and half of the pubertal adolescents. The interobserver variability of these hymenal findings was fair. The prevalence of sexually transmitted infections (STIs) was low, none for the prepubertal children, and only 6% of the adolescent had STI, which was Hepatitis B. Conclusion The clinical profile of sexually abused prepubertal children differed from that of pubertal adolescents. There was a higher incidence of hymenal trauma and STIs in adolescents.
Child Abuse, Sexual

Objectives: Suicidal ideation is a serious concern even among the pediatric population. This study aimed to determine its prevalence among victims of child sexual abuse and the factors that may contribute to its occurrence. Methods: A cross-sectional analytic study was done using medical records of 393 victims of child sexual abuse seen at the PGH CPU from 2017–2019. A logistic regression analysis was performed to assess the associations of age, sex, closest relation to perpetrator, mode, and chronicity of sexual abuse to the presence of suicidal ideation. Results: The prevalence of suicidal ideation among victims of child sexual abuse is 28%. The factors that were found to have a statistically significant association with suicidal ideation were age and closest relation to perpetrator. For each additional year from 6 to 17 years of age, the odds of having suicidal ideation increased by a factor of 1.33 (95% CI 1.19, 1.49; p<0.001). Victims who were abused by an immediate family member had increased odds of suicidal ideation by a factor of 2.12 (95% CI 1.12, 4.03; p=0.021). Conclusion Suicide is prevalent among victims of child sexual abuse. A high index of suspicion should be given to older adolescents and those whose perpetrators are immediate family members.
Suicidal Ideation ; Child Abuse ; Sex Offenses ; Mental Health

Background: Child sexual assault has been underreported, more so, those who minor perpetrators have assaulted. Surveillance for these children, victims and perpetrators alike, must be established. Objective: The objective was to describe the characteristic profile of the minor perpetrators who committed child sexual abuse seen in Philippine General Hospital - Child Protection Unit (PGH-CPU) from January 2013 to December 2018. Methodology: This retrospective cohort study was conducted using chart review and data retrieval from the Child Protection Management Information System (CPMIS) of the PGH-CPU. Results: There were 931 minor perpetrators. 55.9% were 15-19 years old and were predominantly male. 12.7% came from Cavite and 9.5% from Manila. Most were neighbors, acquaintances, and cousins of the victims. 39.4% were still students. 14.4% engaged in alcohol consumption. 7.7% have repeatedly abused children. 6.1% already had police blotter records. 7.3% were exposed to pornography. 7.5% are currently in jail, and 4.1% are in the same household as the victim. Conclusion A child’s environment is potentially contributory to their actions. The minor perpetrators reported were observed to have adverse childhood experiences like violence in their families. Although sexual abuse cases focus on the victims, it is equally vital that authorities give attention to minor perpetrators because they are also children. Programs and interventions should be provided for them to grow up to be better individuals in society.
Sex Offenses ; Child

In 1998, biological samples were collected from the body of a 17-year old female rape-homicide victim within 24 hours post-contact. In the absence of a sexual assault investigation kit, locally available medical supplies were used to collect biological samples. The victim’s family filed a case naming the victim’s uncle as the assailant. More than a year into the trial, samples from the victim and the accused were tested for DNA. The vaginal smears yielded DNA profiles originating from at least two persons, with one DNA source being male. Upon discovery, the victim’s age, the state of her body, and medicolegal examination results supported the allegation of sexual assault rather than consensual sex. This paper described the DNA testing conducted for this rape with homicide case. The prosecution used the DNA test results to support the charges against the accused, who was eventually convicted and sentenced to death in 2001. Upon automatic review in 2004, the Philippine Supreme Court affirmed the conviction and dismissed the defense’s claim that DNA testing violated the defendant’s right against self-incrimination. The defendant’s death conviction was commuted to life imprisonment when the Death Penalty was suspended via Republic Act No. 9346 in 2006. The case described here is considered one of the DNA landmark cases cited in the Philippine Rule on DNA Evidence of 2007.
Sex Offenses ; Microsatellite Repeats

Objective: To investigate the associations between adverse childhood experiences (ACE) and substance use behaviors among lesbians to provide a scientific basis for high-risk population identification and formulation of targeted intervention measures. Methods: Lesbians who participated in routine AIDS voluntary counseling, testing services, activities, and peer recommendations were recruited from July to December 2018, with the help of LesPark in Beijing. Convenient sampling method was used. Demographic characteristics, ACE, and substance use behaviors of subjects were investigated using an online platform powered by www.wjx.cn. Subsequently, the associations between ACE and adulthood substance use behaviors were evaluated using the logistic regression model. The SPSS 22.0 was used for statistical analysis. Results: A total of 294 lesbians were recruited in the study, 81.3% (239/294) of them were lesbians, and 18.7% (55/294) were bisexuals. Besides, 55.8% (164/294) of subjects reported they had had ACE, with proportions of lesbians experiencing abuse, neglect, and family dysfunction as 33.3% (98/294), 24.5% (72/294), and 32.7% (96/294), respectively. 55.1% (162/294) of the lesbians reported they had smoked in the past 30 days, 11.2% (33/294) reported having drug-use behavior in the past three months, and 22.8% (67/294) claimed drinking alcohol weekly. Multivariate logistic regression analysis showed that lesbians with ACE were at high risks to smoke (OR=1.87, 95%CI: 1.13-3.08), drink (OR=2.13, 95%CI: 1.18-3.84), and use drugs (OR=3.33, 95%CI: 1.29-8.61) in adulthood. Moreover, lesbians with childhood family dysfunction were at higher risk of smoking cigarettes (OR=2.60, 95%CI: 1.46-4.62) and drinking alcohol (OR=2.65, 95%CI: 1.44-4.87). At the same time, those with abuse experience were at higher risk of drug use (OR=3.17, 95%CI: 1.26-7.96). Conclusions: Substance use behaviors, including cigarette smoking, drinking alcohol, and drugs use, were common among lesbians. Positive associations were found between ACE and adulthood substance use behaviors.
Adult ; Adverse Childhood Experiences ; Child ; Child Abuse/psychology* ; Female ; Humans ; Risk Factors ; Sexual and Gender Minorities ; Substance-Related Disorders/psychology*