Introduction: Genital herpes in a prepubertal child presents a child protection clinician with a difficult problem: how likely is it that transmission occurred as a consequence of sexual abuse? Published guidelines on the management of sexually transmitted infections in children provide varying recommendations and refer to a limited literature.
Objective: To review the evidence for the likelihood of sexual transmission in a child with proven genital herpes.
Methods: Structured literature search for reports of series of children presenting with genital herpes where an assessment for possible sexual transmission or child sexual abuse had been made.
Results: Five suitable papers were identified. Although just over half of reported cases of genital herpes in children had evidence suggestive of a sexual mode of transmission, the quality of assessment of possible sexual abuse was too weak to enable any reliable estimation of its likelihood. Sexual transmission is reported more commonly in older children (aged > or =5 years), in children presenting with genital lesions alone and where type 2 herpes simplex virus is isolated.
Conclusions: Child protection clinicians should be aware of the weakness of the evidence on the likelihood of sexual transmission of genital herpes in prepubertal children. The US guidance that child sexual abuse is "suspicious" reflects the evidence better than the UK guidance that it is "probable". A larger, more up-to-date, methodologically sound, population based study is required.