Abstract
Summary
A boy aged 15 years infected a girl of 13 years with Chlamydia and genital warts. The boy has been engaged in sexual activities for the last four years. There was no dispute that the boy had had sex with the girl. He was prosecuted but acquitted by the Court on the ground of ‘defence of sleepwalking’. This is the first case where sexually transmitted infections like Chlamydia and genital warts have been transmitted sexually through sleepwalking. This case also raises the issues of underage sex and issues of confidentiality.
A CASE REPORT
A 13-year-old girl attended the genitourinary medicine clinic for the complaint of vaginal discharge and genital warts. On examination she had genital warts. Swabs taken from cervix by a speculum examination confirmed that she also had Chlamydia. She did not have a regular sexual partner and had had sex with one person. On detailed questioning by the police she revealed that her stepbrother has been abusing her since her age of nine. The abuse initially started with digital penetration and recently changed into actual sexual intercourse with full penile penetration. Last time she had had penetrative sex was on 15th September. Her stepbrother, who was 15 at the time, was examined in the genitourinary medicine clinic on 29th September. He was asymptomatic. He had had a regular girl friend for 14 months and was having regular unprotected sex with her. It was not known whether she was examined. He was addicted to alcohol, taking about 30–40 units a week. There was no other history of recreational drug taking like cannabis or crack/cocaine. He was not on any medication for any recognized illnesses. He was fit and well. On examination, he was found to have several tiny warts on the shaft penis and the endo-urethral swab was positive for Chlamydia trachomatis by nucleic acid amplification test. Test for N. gonorrhoeae was positive.
On police questioning, he denied of any knowledge of abusing or having sexual intercourse with the 13-year-old girl. Subsequently, it was transpired that he was abusing the girl while in sleep. There was no family history of sleepwalking. Expert advice was sought on acquiring Chlamydia and genital warts, by the police. After appropriate expert advice the case was dropped.
DISCUSSION
The case raises several issues as follows:
Causes of sleepwalking Physical harm caused by sleepwalking Police prosecution Courts approach to sentencing Acquisition of sexually transmitted infections (STI) through sleepwalking Sexual abuse of children Sexual intercourse under the age of 16 and 13 Issues on consent
Sleepwalking is a form of sleep disorder (parasomnia) medically termed as somnambulism. This is also known as ‘nREM sleep’ (awakening) parasomnia as electrophysiological studies have showed that it is often associated with non-rapid eye movement (nREM). 1 Sleepwalking is mostly familial with highest prevalence drug-induced. The common form is alcohol-induced. There have been no studies on alcohol having a direct effect on sleepwalking. 2 However, it has been proved in the sleep laboratories that alcohol can significantly increase slow wave sleep in the first 2–4 hours of sleep. 2 Subsequently, a distinct type of parasomnia associated with abnormal sexual behaviour was reported and this condition was described as ‘sexomania’. 2 Sexomania was confirmed to be an nREM arousal parasomnia. 3 Atypical sexual behaviours during sleep i.e. violent masturbation, sexual assaults and loud sexual vocalization have been reported. 4 Sometimes the abnormal sexual behaviour, described as somnambulistic sexual behaviour can include normal vaginal penetration, oral sex and anal sex. 5 In one case, a man aged 20 with a positive family history had had regular complete sexual intercourse with his wife with total amnesia. 6 A man was prosecuted for indecent sexual exposure as he was walking naked. When it was known he was sleepwalking the case was dropped. 7 In one study, nine out of 11 cases of parasomnia with abnormal sexual behaviour were involved with children. 8 In December 2005 in Toronto, Canada, a 33-year-old man called Luedecke was prosecuted for sexual assault but was acquitted after a Medical Expert testified it as a case of sexomania. 9 During the same time in December 2005, in a first case of its kind in UK, a 22-year-old man called James Bilton raped a woman of 22 three times. He was acquitted by the Court as he was sleepwalking during these serious offences. 10 This is the first case where two STIs have been transmitted through sleepwalking.
In this case, the victim is only 13. According to the Children Act 1989, the age of consent to sex is 16 in England, Wales and Scotland and 17 in Northern Island. The Sexual Offences Act (SOA), 2003 has created a new rule of law that is, there is no defence of consent, where the sexual activity involves a child under 13. 11 Between 13 and 16 the doctor should be able to detect consensual/non-consensual sexual behaviour and act appropriately according to BASHH guidelines. 12 Every area in UK has a Local Safeguarding Children Board (LSCB) whose function is to ensure the principle ‘the interest of the child is paramount’. There is a child protection service attached to every hospital with a designated personnel. The duty of the doctor is to liaise with him/her on child protection issues. Under the protocols issued by the Area Child Protection Committees in England and Wales, it is mandatory to report to the police all sexually active children under 13 years of age. 13 The legal status of these protocols is not known. Many doctors working in genitourinary (GU) medicine clinics resent this new guideline as this may undermine the confidentiality and trust of the young people attending the GU medicine clinics. The General Medical Council guidance is clear. Confidentiality can be breached without consent only where there is a risk of serious harm to the patient or others. 14