Sexual assault: Difference between revisions
Neil.m.young (talk | contribs) (CDC recommendations 2015) |
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**Receptive anal intercourse 0.5-3% | **Receptive anal intercourse 0.5-3% | ||
== | ==Clinical Features== | ||
==Differential Diagnosis== | |||
==Diagnosis== | |||
===General=== | ===General=== | ||
*Check life threats | *Check life threats | ||
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*[[Abuse (Nonaccidental Trauma)]] | *[[Abuse (Nonaccidental Trauma)]] | ||
== | ==References == | ||
*CDC 2006 guidelines | *CDC 2006 guidelines | ||
Revision as of 18:59, 5 June 2015
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
- Consensual vaginal intercourse 0.1-0.2%
- Receptive anal intercourse 0.5-3%
Clinical Features
Differential Diagnosis
Diagnosis
General
- Check life threats
- Don’t change, shower, etc. pt
- Defer GU examination
- Consent obtained
- Contact SANE (sexual assault nurse examiner) and Local Police (if report not already filed)
Labs
- Pregnancy test
- Consider Plan B
- Td
- Hepatitis B PEP for non-vaccinated
- Hepatitis B immunoglobulin and/or vaccine
- Labs
- Rapid HIV, hep pannel, RPR?
- Consider HIV PEP
- Basic labs, LFTs, if considering HIV PEP
- PD notification
^Currently no PEP for Hep C
Management
- Consider emergency contraception if possibility of pregnancy
- Consider HIV post-exposure prophylaxis
Hepatitis B
- Vaccine 1.0mL IM now, 1-2 months and in 4-6months if pt unimmunized
- Immune Globulin for high-risk exposure (IV drug user or multiple assailants)
Other STDs
- Ceftriaxone 250 mg IM in a single dose PLUS
- Azithromycin 1 g orally in a single dose PLUS
- Metronidazole 2 g orally in a single dose OR
- Tinidazole 2 g orally in a single dose
See Also
References
- CDC 2006 guidelines