Sexually Transmitted Diseases: Forensic Nursing in the ER

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A 17-year-old female (L.M.) presented to the Urgent Care Center with complaints of pain with urination. After taking a history from the patient, this young girl confided that she had been forced to have sex by a 32-year-old male. What initially seemed to be pretty cut and dry turned out to be a life sentence.

Because L.M. was 17, she is legally able to present for treatment for STD, pregnancy and contraceptive issues without a parent. To complicate things, L.M. claimed a rape situation that occurred approximately one week prior to seeking treatment. Due to the lapse of time, a rape kit was not indicated. As a minor, this only made the case more interesting.

On L.M.’s physical exam, several large open blisters were noted on the external genitalia. In addition, the internal genital structures were bright red and irritated. The cervix was friable and had multiple pustules noted on the surface. Cultures were obtained and sent to the lab.

My decisions for treatment of this patient had to be made pending the cultures results. I was one of the most impressive GYN physical exams that I have seen. After the exam was complete, I discussed the findings with the patient. I expressed concern that the lesions noted on the external genitalia were herpes simplex

I also voiced concern about the possibility of multiple other STD’s. L.M. seemed to take the news pretty well until we discussed the reality that she had contracted a life altering virus that would plague her for the rest of her life. We discussed the medical liability of having to report the act of forcible sex to the police. She did not wish to report for fear of the consequences. After a lengthy discussion, realization set in that this man could continue to spread the herpes virus to other young girls and could impact their relationships for the rest of their lives.

The end results for L.M. were very difficult. L.M.’s cultures came back positive for bacterial vaginosis, chlamydia, gonorrhea and herpes simplex. She was treated for each ailment, but will always have reminders of the dreaded event of rape. She did report to the police that there was sexual activity, but claimed that it was consensual. Unfortunately, the perpetrator will not be caught for this act and will probably strike again.

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