1. National guidelines on chain of evidence
Dr K E Rogstad
Royal Hallamshire Hospital
Sheffield

2. Why are they needed
National guidelines produced on managing suspected STIs in children
Recommended chain of evidence for medico-legal specimens but there were no national ones for NHS
Advice from RCPath/rcp joint committee on Infection
Just because chain of evidence difficult to do doesn’t mean it shouldn’t be done

3. development Rcpath formed small group to put together guidelines
Out for consultation Feb
Comments now being integrated into final version
Final version due soon
Will go on rcpath website

4. AIM
To produce a national document which could be used whenever a chain of evidence was needed in NHS (not police forensic swabs) which would be used by clinicians and laboratory staff to save every unit developing their own

5. When should they be used?
suspected STIs in children where abuse possible/suspected
Rape victims STI screen where reported to police and assailant arrested or likely to be

6. When not to be used Adolescents over 13 ears having consenting SI
All children having swabs taken
All rape victims if not reported/ no suspect

7. Problems and solutions
Piloted in Sheffield
Forms needed ammending for local circumstances clinic and lab
Too many chain of evidence samples initiatednow senior doc needs to agree should be done

8. Additional points
If STI found but chain not done, then repeat tests with a chain prior to treatment
Implementation needs close collaboration between labs and clinicians
Tamper proof bags may be used if wished
Guidelines are not for forensic swabs taken by police surgeons
Further info from
Samples of local Sheffield forms available

9. References
National guidelines for management of suspected sexually transmitted infections in children and young people
Thomas A, Forster G, Robinson A, Rogstad K Sex Transm Infect 2002; 78: