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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. 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

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  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

  8. 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

  9. 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

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

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

  12. STIs in children • Sexual abuse – always consider but also • verticaltransmission • accidental transmission • close non-sexual physical contact • voluntary sexual activity

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

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

  19. 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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