ABSTRACT
Sexually transmitted infections (STIs) are infections primarily passed on through person-to-person sexual contact. They cause a variety of clinical diseases but can be asymptomatic. In the context of sexual assault, they can be transmitted during the assault but may be pre-existing in the victim. The methodology for testing for STIs has changed dramatically in recent years which has impacted on the sensitivity and specificity of tests and how they can be used in a legal context. It has also resulted in testing being less invasive and therefore less traumatic and more acceptable to victims and also to forensic practitioners.
There have also been advances in the prevention of STIs following assault and in particular for post-exposure prophylaxis for HIV as well as vaccination against Hepatitis B and Human papillomavirus (HPV).
The presence of STIs and their significance in medicolegal cases is fraught with difficulties. In adults, the presence of an STI can be used as evidence of assault or used to bring into question the previous sexual behavior of the victim and discredit them. In the case of children, an STI may be the first indicator of sexual assault/abuse or used to link a perpetrator to victim; however the possibility of transmission vertically, or fomite transmission can be used to argue against sexual transmission and a false diagnosis of sexual abuse can have major long-term repercussions on the child, parents or carers and other children in the family.
