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Association between STI and child sexual exploitation in children under 16 years old attending sexual health clinics in England: findings from a case–control study
  1. Chris Ward1,
  2. Gwenda Hughes2,
  3. Holly D Mitchell2,
  4. Karen E Rogstad3
  1. 1 The Hathersage Centre, Manchester University NHS Foundation Trust, Manchester, UK
  2. 2 Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
  3. 3 GUM, Royal Hallamshire Hospital, Sheffield, UK
  1. Correspondence to Dr Chris Ward, The Hathersage Centre, Manchester University NHS Foundation Trust, Manchester, Manchester, UK; chris.ward{at}


Objective Child sexual exploitation (CSE) can be difficult to identify, as there may be few reliable indicators. Although they may be used in decision-making, there is no evidence that STIs are predictors of CSE. We investigated the relationship between STI presentation at sexual health clinics (SHCs) and CSE.

Methods SHCs with 18 or more children aged 13–15 years old with STI diagnoses in 2012 were identified using the Genitourinary Medicine Clinic Activity Data Set STI Surveillance System. Cases with confirmed bacterial or protozoal STIs were matched by age, gender and clinic with non-STI controls. Lead clinicians were asked to complete an online questionnaire on CSE-related risk factors of cases and controls irrespective of STI presence. Associations between STI outcome and CSE-related risk factors were analysed using conditional logistic regression.

Results Data were provided on 466 children aged 13–15 years old; 414 (89%) were female, 340 (80%) were aged 15, 108 (23%) were aged 14, and 18 (3.9%) were aged 13 years. In matched univariate analysis, an STI diagnosis was significantly associated with ‘highly-likely/confirmed’ CSE (OR 3.87, p=0.017) and safeguarding concerns (OR 1.94, p=0.022). Evidence of an association between STI diagnosis and ‘highly-likely/confirmed’ CSE persisted after adjustment for partner numbers and prior clinic attendance (OR 3.85, p=0.053).

Conclusion Presentation with bacterial or protozoal STIs in children aged 13–15 years old at SHCs may be considered a potential marker for CSE. It would be prudent to consider CSE, indepth assessment and potential referral for any children under 16 years old presenting with a bacterial or protozoal STI.

  • children
  • CSE
  • exploitation
  • STIs

Statistics from


  • Handling editor Jane S Hocking

  • Contributors CJW, GH and KER conceived the study, and all authors contributed to study design. CJW led the study, developed the questionnaire and coordinated data collection. HDM identified eligible patients and matched controls in the GUMCAD surveillance system and performed statistical analyses. All authors were involved in the interpretation and presentation of the results. CJW drafted the manuscript with critical input from GH, HDM and KER.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval As Genitourinary Medicine Clinic Activity Data Set (GUMCAD V.2) is a routine public health surveillance activity, no specific consent was required from the patients whose data were used in this analysis. PHE has permission to handle data obtained by GUMCAD V.2 under section 251 of the UK National Health Service Act of 2006 (previously section 60 of the Health and Social Care Act of 2001), which was renewed annually by the ethics and confidentiality committee of the National Information Governance Board until 2013. Since then the power of approval of public health surveillance activity has been granted directly to PHE. The study was reviewed by PHE Research and Development and confirmed to be a service evaluation of the standard of care for assessing CSE, involving an intervention currently in use, without treatment, samples or additional investigations.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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