STI testing

The need for testing for STIs should be considered on a case-by-case basis by examiners and patients. Testing at the time of the initial exam does not typically have forensic value if patients are sexually active and an STI could have been acquired prior to the assault. Also, despite rape shield laws, there may be a concern that positive test results could be used against patients (e.g., to suggest sexual promiscuity). There may, however, be situations in which testing has legal purposes, as in cases where the threat of transmission or actual transmission of an STI was an element of the crime. Or, for nonsexually active patients, a baseline negative test followed by an STI could be used as evidence, if the suspect also had an STI.

Among sexually active patients, the identification of STIs after an assault is usually more important for psychological and medical management than for forensic purposes.[1] Trichomoniasis, bacterial vaginosis (BV), gonorrhea, and chlamydial infection are the most frequently diagnosed infections among sexually assaulted women.[2] Their presence does not necessarily indicate acquisition during the assault, since these infections are prevalent among sexually active women. The medical forensic exam presents an opportunity to identify preexisting STIs, regardless of when they were acquired, and for examiners to make recommendations for specific treatment. Testing for STIs at the time of the exam also gives examiners and patients the option of deferring treatment until it is needed.
Seek the informed consent of patients for testing, if indicated, following CDC guidelines. (For more information on this topic, see A.3. Informed Consent.)

[1] This paragraph is drawn from Sexually Transmitted Diseases Treatment Guidelines, 2002, p. 69.
[2] Chlamydial and gonococcal infections in women are of particular concern due to the possibility of ascending infection. In addition, postassault testing can detect hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infection (Sexually Transmitted Diseases Treatment Guidelines, 2002, p. 69).


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