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%
- Receptive anal intercourse 0.5-3%
Workup
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
- ABO, RPR, Hep B, HIV, EtOH, hCG, Utox, G&C/wet mount
- HIV test now, 6wk, 3months, 6months
- CBC, Chem 10, LFTs if will need HIV PPx
Treatment
- Consider emergency contraception if possibility of pregnancy
STD
- GC
- Ceftriaxone 125mg IM or Cipro 500mg po x1 or Ofloxacin 400mg po x1
- Chlam
- Azithromycin 1g PO x1 or Doxycyclin 100mg po bid x7d
- Trich
- Metronidazole 2g PO x1 or 500mg po bid x 7d
- Syphilis
- Pen G benzathine 2.4million U IM x1
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)
HIV
- Consider Post Exposure Prophylaxis (PEP)
- Initiate within 72h (best within 36h) x 28d
- Zidovudine 300mg bid or 200mg tid + Lamivudine 150mg bid
OR
- Tenofovir + Emtricitabine
See Also
Source
- CDC 2006 guidelines