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

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social aspects of chain of evidence

Social aspects of chain of evidence

Dr Jan Welch

King’s College Hospital

the haven camberwell
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

stis and rape
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
stis as evidence
STIs as evidence

Likely to be relevant in:

  • abused children
  • sexually inexperienced adults or orifice
  • the elderly
sti evidence and laws on disclosure
STI evidence and laws on disclosure
  • Historical protection of Venereal Diseases Acts limited
  • Identified infections may become available to courts
  • Prophylactic antibiotics increasingly used
stis as evidence medico legal considerations
STIs as evidence: medico-legal considerations
  • Choice of tests
  • Management of the sample
choice of tests
Choice of tests


  • Well validated
  • Capable of confirmation eg culture

But newer methods (NAATs) increasingly used for eg chlamydia

management of the sample
Management of the sample
  • Chain of evidence
  • Storage of sample (ideally in duplicate at –70o)
  • Additional tests eg reference laboratory for typing
  • Overseen by senior
  • Ideally ‘M/L’ protocol agreed with clinicians
case study lucy aged 8

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

lucy 2

Lucy 2

Social services alerted

Lucy taken into care

Lucy assessed by community paediatrician and forensic medical examiner

lucy 3

Lucy 3

Lucy denies being abused

Repeat swab taken for chlamydia

Result: negative

Lucy returns home

stis in children
STIs in children
  • Sexual abuse – always consider

but also

  • verticaltransmission
  • accidental transmission
  • close non-sexual physical contact
  • voluntary sexual activity
stis in children management
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
case study saffron aged 4
Case study – Saffron aged 4

15th March

  • Childminder notices discharge on child’s underwear
  • GP treats for thrush and takes swab

22nd March

  • Gonorrhoea culture positive - PPNG
  • Child given ciprofloxacin
  • Social services notified
saffron 2
Saffron 2

26th March

  • Medical examination shows hymenal tear

7th April

  • Child protection conference
  • Mother threatens to abscond to Jamaica
  • Saffron taken into police protection
saffron 3
Saffron 3


  • 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
saffron 4
Saffron 4


  • 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
saffron 5
Saffron 5


Decision by court

  • Evidence of abuse but father not implicated
  • Saffron returned to mother with support and supervision
stis and evidence summary
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