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A 15 year old girl is brought in by her uncle for a chief complaint of vaginal discharge (he explains that her parents are working and unable to bring her in). She has yellow vaginal discharge and cervical motion tenderness on exam. Her pelvic exam is otherwise unremarkable. She has a linear bruise on her neck, some circular marks on her right dorsal hand, and some linear hyperpigmented marks on her right volar wrist. She shrugs her shoulders when asked how these occurred. Her uncle states that she “does it to herself.” She avoids eye contact, is not very conversant, and her uncle answers most of her questions for her. She shakes her head “no” when asked about depression or suicidality.
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January 31, 2018 at 3:13 pm
The answer is D. Being present with an older “friend” or “family member” who doesn’t allow the patient to answer questions or talk with the provider alone, a patient that appears anxious and is avoidant in terms of speaking with the provider, STD symptoms, signs of ligature marks (neck), patterned bruises (cigarette burns on hand), bite marks, and intimate body area tattoos are some signs of human trafficking. While the patient may be suicidal or engaging in IV drug abuse, the primary concern is recognition of potential human trafficking. Tubo-ovarian abscess is unlikely without adnexal tenderness, and selective mutism would be a diagnosis of exclusion given the concerning signs for trafficking. For more on recognizing human trafficking: https://polarisproject.org/human-trafficking/recognize-signs