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Social aspects of chain of evidence Dr Jan Welch King’s College Hospital.

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Presentation on theme: "Social aspects of chain of evidence Dr Jan Welch King’s College Hospital."— Presentation transcript:

1 Social aspects of chain of evidence Dr Jan Welch King’s College Hospital

2 The Haven, Camberwell 24/7 sexual assault referral centre Opened May 2000, 24/7, for adults initially 12 boroughs of South London Part of Department of Sexual Health Provided in partnership with the Metropolitan Police 2 further centres opening 2004

3 STIs and rape STIs found in 4-56% of raped women Often reflect pre-existing infection Character denigration in court STI evidence seldom useful in the sexually active

4 STIs as evidence Likely to be relevant in: abused children sexually inexperienced adults or orifice the elderly

5 STI evidence and laws on disclosure Historical protection of Venereal Diseases Acts limited Identified infections may become available to courts Prophylactic antibiotics increasingly used

6 STIs as evidence: medico-legal considerations Choice of tests Management of the sample

7 Choice of tests Ideally: Well validated Capable of confirmation eg culture But newer methods (NAATs) increasingly used for eg chlamydia


9 Management of the sample Chain of evidence Storage of sample (ideally in duplicate at – 70 o ) Additional tests eg reference laboratory for typing Overseen by senior Ideally ‘M/L’ protocol agreed with clinicians

10 Case study: Lucy aged 8 Lucy presented to her GP with a discharge 5 days after a bicycle accident Genital swab sent to laboratory (no chain of evidence) Result: +ve for chlamydia

11 Lucy 2 Social services alerted Lucy taken into care Lucy assessed by community paediatrician and forensic medical examiner

12 Lucy 3 Lucy denies being abused Repeat swab taken for chlamydia Result: negative Lucy returns home

13 STIs in children Sexual abuse – always consider but also vertical transmission accidental transmission close non-sexual physical contact voluntary sexual activity

14 STIs in children - management Microbiology / GUM / paediatrics Screen for other infections M/L – chain of evidence and procedures Tests – predictive value in population Additional – biopsy / typing / cultures Reference laboratory Care with drugs

15 Case study – Saffron aged 4 15 th March  Childminder notices discharge on child’s underwear  GP treats for thrush and takes swab 22 nd March  Gonorrhoea culture positive - PPNG  Child given ciprofloxacin  Social services notified

16 Saffron 2 26 th March  Medical examination shows hymenal tear 7 th April  Child protection conference  Mother threatens to abscond to Jamaica  Saffron taken into police protection

17 Saffron 3 April  Mother and estranged father attend different GUM clinics for tests  Mother has PPNG (recent partner from Jamaica but he had no contact with child)  Father has fully sensitive strain of GC

18 Saffron 4 November  Proceedings heard in High Court  Father denied abuse  Mother shared bed, bath, towels and flannels with Saffron  Reference laboratory – typing showed father had unrelated strain

19 Saffron 5 November Decision by court  Evidence of abuse but father not implicated  Saffron returned to mother with support and supervision

20 STIs and evidence - summary May not be straightforward Diagnosis of an STI can have major implications M/L procedures useful but laboratory procedures crucial Need to determine role of new technologies Multi-professional considerations


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