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
Differential Diagnosis
Diagnosis
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
- 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
^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 patient 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