Sexual assault: Difference between revisions
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===Empiric Antibiotics for [[STDs]]=== | ===Empiric Antibiotics for [[STDs]]=== | ||
[[File:Nonoccupational HIV algorithm.png|thumb|HIV nonoccupational exposure algorithm]] | [[File:Nonoccupational HIV algorithm.png|thumb|HIV nonoccupational exposure algorithm]] | ||
*[[Ceftriaxone]] | *[[Ceftriaxone]] 500mg IM in a single dose (1000mg if weight >= 150 kg) '''AND''' | ||
*[[Azithromycin]] 1g orally in a single dose '''AND''' | *[[Doxycycline]] 100mg orally twice a day for 1 week '''AND''' | ||
**[[Azithromycin]] 1g orally in a single dose for pregnant patients '''AND''' | |||
*[[Metronidazole]] 2g orally in a single dose '''OR''' | *[[Metronidazole]] 2g orally in a single dose '''OR''' | ||
**[[Tinidazole]] 2g orally in a single dose | **[[Tinidazole]] 2g orally in a single dose | ||
Revision as of 02:50, 9 February 2021
Background
- Male victim in 10% of cases
- Toluidine blue: detects vulvar tears
- Wood's lamp: detects semen stains
Risks
- Pregnancy
- Without contraception 1-5%
- If mid-cycle (days 14-16) risk is higher
- STD (5-10%)
- HIV
- Theoretically higher risk of transmission in sexual assault than consensual due to physiological factors
- Consensual receptive vaginal intercourse 0.1-0.2%
- Consensual receptive anal intercourse 0.5-3%
Clinical Features
- History of sexual exposure without consent
- May or may not have symptoms/signs of injury
Differential Diagnosis
Genitourinary Trauma
- Urinary system
- Genital
- Other
- Child abuse
- Pelvic fracture (often accompanies)
- Sexual assault
Evaluation
General
- Check for life threats, emergent medical needs, and injuries first
- If patient consents to forensic exam after medical evaluation
- Ask patient not to change, shower, eat, drink, or wash hands
- Do not give wet wipe and ask patient not to wipe when giving urine sample. Collect dirty catch urine
- Defer GU examination if patient consents to SANE (sexual assault nurse examiner) exam
- Contact SANE (sexual assault nurse examiner) and police (if report not already filed and patient consents, or if required by law)
Labs
- Pregnancy test
- Rapid HIV
- Hepatitis panel
- Hepatitis B surface antigen
- Hepatitis C viral load
- RPR
- Urine GC/chlamydia, if not collected by SANE
- If considering HIV PEP, need baseline labs
- CBC
- Chemistry
- LFTs
Management
- Consider emergency contraception if possibility of pregnancy
Empiric Antibiotics for STDs
- Ceftriaxone 500mg IM in a single dose (1000mg if weight >= 150 kg) AND
- Doxycycline 100mg orally twice a day for 1 week AND
- Azithromycin 1g orally in a single dose for pregnant patients AND
- Metronidazole 2g orally in a single dose OR
- Tinidazole 2g orally in a single dose
- HIV post-exposure prophylaxis
- Post-exposure prophylaxis (PEP) recommended as soon as possible if <= 72 hours since exposure AND
- Assailant HIV positive
- Assailant HIV status unknown, but patient's mucous membranes or non-intact skin exposed to blood, semen, vaginal secretions, or bloody body fluids
- Post-exposure prophylaxis (PEP) recommended as soon as possible if <= 72 hours since exposure AND
Vaccines
- Tetanus vaccine
- Hepatitis B post-exposure prophylaxis
- Even if patient is vaccinated, give HBV vaccine booster shot, preferably within 24 hours of exposure[1]
- HPV vaccine for female patients age 9-26 and male patients 9-21 if patient has not already completed series of 3 vaccines[2]
- Remember to attend to patient's emotional needs as well, consider social work consult and/or offering support resources such as [Rape, Abuse & Incest National Network] 800-656-HOPE
Disposition
- Typically outpatient
See Also
External Links
References
- ↑ CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm
- ↑ CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm