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 – While rare, it is the most commonly sexually transmitted disease in sexually abused children. May appear symptomatically on lips, tongue, palate, face, and especially pharynx in forms ranging from erythema to ulcerations and from vesiculopustular to pseudomembranous lesions; oral and perioral gonorrhea in prepubertal children is pathognomonic of sexual abuse.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.