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
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 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
- There is currently no PEP for Hep C
See Also
References
- CDC 2006 guidelines