Should children exposed to sexual abuse be offered human papillomavirus (HPV) vaccination alongside screening for sexually transmitted infections? A recent article in the Lancet argues for a yes answer.
The WHO defines childhood sexual abuse as the involvement in sexual activity of a child under the age of 18 years who did not give informed consent or is not developmentally prepared.
The global prevalence of childhood sexual abuse is estimated to be 8–31% for girls and 3–17% for boys. The true figures are probably nearer the upper figure.
According to a review, parents were the perpetrators of about 45% of cases of childhood sexual abuse in the USA, and other relatives were responsible for a further 19%. Others included figures of authority such as priests and teachers. Survivors of such abuse are often hesitant to report such incidents because of shame and fear of retribution. Thus, the incidence and prevalence of childhood sexual abuse is almost certainly underestimated.
A previous study from Australia reported that people who have experienced childhood sexual abuse are more likely to engage in risky behaviours associated with cervical cancer, such as an increased number of sexual partners, sex work, and cigarette smoking. Drug and alcohol use and depression are also more common in victims of childhood sexual abuse.
Over two thirds of childhood sexual abuse (70%) occurs at a mean age of 10–11 years, which is younger than the age at which human papillomavirus vaccinations are administered.
Since early virus exposure thus reduces later human papillomavirus vaccine efficacy it would make sense to administer HPV vaccine as soon as childhood sexual abuse is reported.