nbmef1, 3yr w/ perianal warts - gowest

[ArchivalUser]

Also you must rule out sexual abuse, so i will go with d

[ArchivalUser]

Hey y'all.....calling back on this Q plz. still got some doubts.

Its clearly stated, there were no intravag warts and no vag or anal tears. This almost rules out penetration right?

So how wud vag and anal cultures for chlamydia/gono help? Also thr shd hv bn some signs of discharge.
So like someone suggested, cud it be tht the NEXT STEP in Mx is simply Laser therapy of the girls warts (coz it IS quite extensive with bleeding and all).

Anyhow, i do agree the kids warts are very suspicious.

what if there was a choice F) Report to Child Protective Services or G) Enquire from mother about change in childs behaviour or smthng like that. Shd tht be chosen over culture?

[ArchivalUser]

If u suspect child abuse u will 1st report it to child protective services then go on to testing

[ArchivalUser]

even with the choices f and g i would still think d is the better answer

then next step would be g, then if her response is suspicious , we would proceed to choice f .
as far as absence of intravaginal warts, bear in mind that child (sexual) abuse does not always entail penetration. i saw a similar q in uw peds which emphasised this point

[ArchivalUser]

thanks for tht bit of info farha.

so inspite of no penetration, can sm1 still contract chlamydia/gono? And if the cultures are neg is that taken to be sensitive, ie. can u r/o sexual abuse?

[ArchivalUser]

in smaller kids throat cultures can be positive even in absnce of any genital infection ( ie suspect oral sexual abuse).

the possibiity of child self infecting herself genitally post an oral infection is also a possibility (albeit remote)

if cultures are negative that rules out infection only, abuse may still be suspected , ithink..ie perpetrator need not necessarily be infected?

[ArchivalUser]

D
Condiloma acuminta(HPV 6,11) is a STD you should look for others STD! at least 50% of the cases of condyloma acuminata in children are the result of sexual abuse
E Laser ablation is good for intravaginal or cervical lesions
A/B/C answer i think is not logical in this time because you should take care of the child in this moment!