Sexual assault

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%
  • Consensual receptive anal intercourse 0.5-3%

Clinical Features

• History of sexual exposure

Differential Diagnosis

Genitourinary Trauma

• Urinary system
  • Renal trauma
  • Ureter trauma
  • Bladder trauma
  • Urethral trauma
    • Traumatic foley catheter removal
• Genital
  • Penile trauma
    • Traumatic foley catheter removal
  • Testicular trauma
  • Vaginal trauma
• Other
  • Child abuse
  • Pelvic fracture (often accompanies)
  • Sexual assault

Evaluation

General

• Check for life threats first
• Ask patient not to change, shower, eat, or drink
• Defer GU examination
• Contact SANE (sexual assault nurse examiner), if patient consents, and police (if report not already filed and patient consents, or if required by law)

Labs

• Pregnancy test
• Rapid HIV
• consider hepatitis panel, RPR
• GC/chlamydia, if not collected by SANE
• Basic labs, LFTs, if considering HIV PEP

Management

• Consider emergency contraception if possibility of pregnancy
• Hepatitis B post-exposure prophylaxis
• Consider HIV post-exposure prophylaxis
• Tetanus vaccine

Other STDs

• Ceftriaxone 250mg IM in a single dose AND
• Azithromycin 1g orally in a single dose AND
• Metronidazole 2g orally in a single dose 'OR
  • Tinidazole 2g orally in a single dose

There is currently no PEP for Hep C

Disposition

• Typically outpatient

See Also

• HIV post-exposure prophylaxis
• Child abuse
• Occupational exposure