Sexual assaults (SA) are a growing public health issue, with increasing cases in Spain and associated sexually transmitted infections (STIs) risk, especially among women.1 However, STI detection does not necessarily imply transmission during the assault, as many infections are asymptomatic and prevalent in the general population. Unlike other European countries, Spain lacks universal STI screening, limiting testing to at-risk individuals. This study compares STI prevalence among SA victims and women with urinary tract infection (UTI) symptoms and negative cultures, to assess whether broader screening criteria should be considered.
A retrospective study was conducted in a tertiary hospital (January 2022–November 2024) including SA victims and women with UTI symptoms and negative urine cultures who underwent extended STI screening. In the SA group, 121 endocervical swabs, 32 cervicovaginal swabs, 2 rectal, 2 urine, and 1 pharyngeal sample were analyzed. In the UTI-suspected group, 152 midstream urine samples were analyzed. PCR was used to detect Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG) using the RQ-Seven-STI kit (AB Analitica®) for the SA group and the Abbott kit for UTI-suspected patients.2 Serologies for HIV, HBV (anti-HBc), HCV, and Treponema pallidum (TP), using a treponemal assay (Cobas®) were also performed in the SA group.
In total, 157 PCRs were performed in 156 SA victims (155 women, 1 man; median age: 24). The UTI group included 152 women (median age: 25). Table 1 shows the prevalence of targets analyzed in both groups. Four coinfections were detected in the UTI cohort: 1 MG+TV, 1 NG+TV, 1 NG+CT and 1 CT+MG. Statistical analysis included chi-square and Fisher's exact test (for NG) due to low counts.
Initial serologies were performed in 91% of SA victims. T. pallidum antibodies were detected in 2.8%, anti-HBc in 0.7%, and anti-HCV in 1.4%. Follow-up was completed in 37.8%, with no new infections. Of those, 52.5% had one follow-up, 44% had two, and only 3.4% had the full series (at 1, 3, and 6 months). Most victims (66.3%) were evaluated within 24h post-assault; 33.7% after 24h or with missing time data.
In the SA group, 83.9% (131/156) of patients received STI (azithromycin, ceftriaxone and metronidazole) and HIV prophylaxis, 3.2% (5/156) only received STI prophylaxis and the remaining patients did not receive prophylaxis (8.3%) or had missing data (5,1%). Because UTI was the initial clinical suspicion, no patients in the UTI group received STI prophylaxis.
STI prevalence was significantly lower in SA victims (8.3%) than in the UTI group (19.7%), suggesting the need to expand screening criteria. CT and MG were the most frequent pathogens across cohorts, though more prevalent in UTI cases. TV showed the largest difference (0.6% vs. 4.6%), approaching statistical significance.
The 4.5% CT prevalence in SA victims aligns with the lower end of European reports (6.4–17.4%)3–7 and Spanish data (5.1–9.24%).8,9 MG prevalence was higher than national estimates (3.2% vs. 0.34%),8,9 but similar to other studies.5 The substantial STI detection among women with nonspecific urinary symptoms (19.7%) highlights the risk of underdiagnosis when screening is limited to classical indications. This poses a significant public health concern, particularly given the asymptomatic nature and reproductive complications associated with CT and MG.10
Although the prevalence of HIV and syphilis in the initial evaluation of SA victims was low, syphilis was more frequent in our cohort (2.8%) than previously reported (0.34%),8 reinforcing the importance of serological follow-up. Findings for viral hepatitis aligned with earlier studies,9 though some variation exists.3
A limitation of this study was the inability to determine whether detected STIs were assault-related, since most victims were tested too early for PCR detection of newly acquired infections. Given the young median age of the cohort, many infections were likely preexisting. Additionally, differences in specimen types and assay performances between groups could affect diagnostic sensitivity. The absence of clinical data (e.g., sexual history, symptoms) also limits further analysis.
Overall, STI prevalence among SA victims was clinically relevant but significantly lower than in the UTI cohort. These findings support reconsidering current screening strategies to include women with nonspecific urinary symptoms. Furthermore, improving adherence to post-assault serological follow-up is essential, as only 3.4% completed the recommended schedule. Future research should explore cost-effectiveness and incorporate more detailed clinical and sociodemographic information.
Authors’ contributionsMaría Jesús Castaño, Eliseo Albert Vicent, Andrea Medina Piña and Katherine Villarruel Yánez: data curation and analysis. María Jesús Castaño and Eliseo Albert Vicent: study design and manuscript drafting. All authors approved the final version of the manuscript.
Ethical considerationsThis study does not involve the use of human or animal subjects. All data were anonymized prior to analysis and handled to preserve patient privacy and confidentiality. The study protocol was approved by the Ethics Committee for Research with Medication (CEIm) of the Hospital Clínico Universitario de València (N°. exp. 2025/173).
Informed consentGiven that this is a retrospective study based exclusively on anonymized microbiological data obtained during routine clinical practice, the Ethics Committee for Research with Medication (CEIm) of the Hospital Clínico Universitario de València reviewed the protocol and waived the requirement for written informed consent (N°. exp. 2025/173). No information that could identify the patients is included.
Declaration of generative AI and AI-assisted technologies in the writing processNo generative AI or AI-assisted technologies were used in the analysis of the data or in the writing of this manuscript.
FundingThe authors declare that no funds, grants, or other support were received.
Conflict of interestThe authors have no relevant competing interest to disclose about this work.
