Sexual Abuse

The following orofacial manifestations are often signs of sexual abuse and should always be reported to law enforcement and/or child protection with recommended follow-up medical testing and treatment as part of the treatment plan:^11,15,16

• Gonorrhea and Chlamydia – While rare, in prepubertal children, rates are higher in sexually abused adolescents (12%) with gonorrhea; 14% with Chlamydia). May appear symptomatically on lips, tongue, palate, face, and especially pharynx in forms ranging from erythema to ulcerations and from vesiculopustular to pseudomembranous lesions. ¹⁶

• Condylomata Acuminata (veneral warts) – Appear as single or multiple raised, pedunculated, cauliflower-like lesions. In addition to the oral cavity, lesions may also be found on the anal or genital areas.

• Syphilis – Manifests as a papule on the lip or dermis at the site of inoculation; the papule ulcerates to form the classic chancre in primary syphilis and a maculopapular rash in secondary syphilis.

• Herpes simplex virus, Type 2 (HSV-2) – Herpes simplex virus, Type 2 (genital herpes), presents as an oral or perioral, painful, reddened area with a grape-like cluster of vesicles (blisters) that rupture to form lesions or sores. Can also be transmitted vertically from mother to infant during birth, or horizontally through nonsexual contact from a child or caregiver’s hand to the genitals or mouth.^17,18

• Unexplained erythema, ecchymosis and/or petechiae – Such trauma at the junction of the hard and soft palate may indicate forced oral sex.