a. Prepubertal children. Routine testing for STDs is not needed, but STD testing should be considered in children with specific risk factors, including known or clinically suspected STD, sibling of a child with known STD, genital discharge or anal or genital injury present on exam, or perpetrator with known or suspected STD.
b. Pubertal and postpubertal adolescents. Adolescents who describe sexual contact that could transmit an STD should be tested routinely, with culturing for Neisseria gonorrhea and Chlamydia, wet mount of secretions for trichomonas (in girls), and rapid plasmin reagin (RPR). Consider hepatitis B virus and HIV testing.
2. Drug screening. Routine testing is not recommended. Consider if history or exam suggest drug or alcohol use.
3. Forensic evidence collection ("rape kit"). Attempt to collect and preserve physical evidence of seminal fluid, blood, saliva, or pubic hair from perpetrator. Typically, collection is guided by specific protocols using prepackaged collection "kits."
a. Prepubertal children. Collection of forensic evidence is often limited in prepubertal children by types of sexual contacts typically experienced and interval between sexual contact and evaluation. A selective approach is warranted based on history and physical findings. Higher yields of positive forensic evidence come from clothing and bedclothes than from child's body.
b. Pubertal and postpubertal adolescents. Forensic evidence should be collected if adolescents present for evaluation within 72 hours (some protocols specify within 96 hours) of sexual contact that is likely to transfer secretions from perpetrator.
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