47 Genital, rectal, or pharyngeal Neisseria gonorrhea infection 48 Syphilis 49 Genital or rectal Chlamydia trachomatis infection 50 Trichomonas vaginalis infection 51 HIV, if transmission by blood or contaminated needles has been ruled out Section Findings diagnostic of sexual abuse 52 Pregnancy 53 Semen identified in forensic specimens taken directly from a child’s body a Follow-up examination is necessary before attributing these findings to trauma Adaptated from Adams JA, Farst KJ, Kellogg ND Interpretation of medical findings in suspected child sexual abuse: An update for 2018 J Pediatr Adolesc Gynecol 2018;31:225–231 Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology With permission NONACUTE SEXUAL ABUSE Children presenting >72 hours after alleged sexual abuse may be referred to child sexual abuse clinic or child advocacy center for medical evaluations as a more suitable environment for nonacute care needs if asymptomatic and there is absence of contact with alleged offending perpetrator A screening evaluation to satisfy Emergency Medical Treatment and Labor Act (EMTALA) requirements is indicated Assessment of the child’s safety including the need for reporting to the CPS agency and/or law enforcement agency (based upon specific jurisdiction laws of your state) is required as part of this abbreviated ED visit This approach is predicated on the lack of any symptoms that may warrant concerns for an urgent medical examination in the ED (i.e., pain, dysuria, bleeding) If any medical concerns exist, a complete medical evaluation is warranted, with follow-up care at the child sexual abuse clinic or child advocacy center medical clinic The interpretation of nonacute sexual abuse examination findings requires significant knowledge of normal anatomy, including normal variants, other medical conditions that may be confused with sexual abuse examination findings, and examination findings which could be considered supportive of healed penetrating trauma ( Table 127.7 ) Over- and underinterpretation of nonacute findings may cause undue harm to