Sexual assault

Workup

1. Check life threats
2. Don’t change, shower, etc. pt
3. Consent obtained
4. Contact SANE (sexual assault nurse examiner)

Risk Factors

1. Risk of pregnancy without contraception 1-5%; if mid-cycle (days 14-16) risk is higher
2. Risk of STD 5-10%
3. Risk of HIV: consensual vaginal intercourse 0.1-0.2%; receptive anal intercourse 0.5-3%

Workup

1. ABO, RPR, Hep B, HIV, EtOH, icon, Utox, G&C/wet mount
2. HIV test now, 6wk, 3months, 6months
3. CBC, Chem 10 if HIV PPx

Treatment

Pregnancy

Yuzpe ethinyl estradiol 100macg po plus levonorgestral 0.5mg po; repeat in 12h

OR

Plan B levonorgestrel 0.75mg po q12h x2

STD

Gonorrhea: Ceftriaxone 125mg IM or Cipro 500mg po x1 or Ofloxacin 400mg po x1

PLUS

Chlaymdia: Azithromycin 1g PO x1 or Doxycyclin 100mg po bid x7d

PLUS

Trich: Metronidazole 2g PO x1 or 500mg po bid x 7d

Syphilis: Pen G benzathine 2.4million U IM x1

Hepatitis B

Virus vaccine 1.0mL IM now, 1-2 months and in 4-6months if pt unimmunized

Hep B Immune Globulin for high-risk exposure (IV drug user or multiple assailants)

HIV

Initiate within 72h (best within 36h) x 28d

Zidovudine 300mg bid or 200mg tid

PLUS

Lamivudine 150mg bid;

OR

Tenofovir

PLUS

Emtricitabine

See Also

ID: HIV Prophylaxis (Non-Occupational)

Source

DeBonis 12/1/08 adapted from the CDC 2006 guidelines