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INTRODUCTION
Wrong diagnosis of child sexual abuse may lead to serious punishments or complete acquittal of
the perpetrator and secondary victimization of the child. This case highlights the importance of
meticulous medico-legal investigations to exclude the differential diagnosis before arriving at
medico-legal conclusions in order to prevent serious social and medico-legal implications.
CASE REPORT
An 8 year old girl with genital ulceration disease (GUD) was transferred to a gynecology unit of
provincial general hospital. The Venereologist examined the child, and based on the clinical
picture the diagnosis was confirmed as “Genital herpes” and antiviral drug treatment was started.
However, the swab culture performed by the dermatologist was negative for herpes simplex virus.
; Since this condition is highly suggestive of sexual abuse, the child was referred to Judicial Medical
Officer (JMO) for medicolegal investigations. Child and the guardian refused any form of sexual
abuse and they related the condition to a leech bite. Mother was abroad and father works in
Colombo and comes home every two weeks. On examination, the child had fever, myalgia and
tender inguinal lymphadenopathy. Vulva was red and swollen with watery blisters and superficial
scars. The hymen was intact.
JMO referred the scrapings of the lesions to the Histopathologist. Histopathology showed
uniformly stained fibrinous material and infection of virus was unlikely. Samples for HSV
antibody tests for both type -1 and 2 IgG arid IgM antibody tests were also negative. Alleged child
sexual abuse was excluded.
CONCLUSIONS
Degree of probability of ascertaining the diagnosis may be different in clinical practice and
medicolegal cases. In genital ulceration disease, probable clinical diagnosis is sufficient for
medical management but for medico-legal management, the diagnosis should be beyond
- j reasonable doubt in order to achieve justice as well us to prevent secondary victimization.
