Sexual assault: Difference between revisions
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==Workup== | ==Workup== | ||
#Check life threats | |||
#Don’t change, shower, etc. pt | |||
#Consent obtained | |||
#Contact SANE (sexual assault nurse examiner) | |||
==Risk Factors== | |||
#Risk of pregnancy without contraception 1-5%; if mid-cycle (days 14-16) risk is higher | |||
#Risk of STD 5-10% | |||
#Risk of HIV: consensual vaginal intercourse 0.1-0.2%; receptive anal intercourse 0.5-3% | |||
==Workup== | |||
#ABO, RPR, Hep B, HIV, EtOH, icon, Utox, G&C/wet mount | |||
#HIV test now, 6wk, 3months, 6months | |||
#CBC, Chem 10 if HIV PPx | |||
== | |||
ABO, RPR, Hep B, HIV, EtOH, icon, Utox, G&C/wet mount | |||
HIV test now, 6wk, 3months, 6months | |||
CBC, Chem 10 if HIV PPx | |||
==Treatment== | |||
===Pregnancy=== | ===Pregnancy=== | ||
Yuzpe ethinyl estradiol 100macg po plus levonorgestral 0.5mg po; repeat in 12h | Yuzpe ethinyl estradiol 100macg po plus levonorgestral 0.5mg po; repeat in 12h | ||
| Line 45: | Line 22: | ||
Plan B levonorgestrel 0.75mg po q12h x2 | Plan B levonorgestrel 0.75mg po q12h x2 | ||
===STD=== | ===STD=== | ||
Gonorrhea: Ceftriaxone 125mg IM or Cipro 500mg po x1 or Ofloxacin 400mg po x1 | Gonorrhea: Ceftriaxone 125mg IM or Cipro 500mg po x1 or Ofloxacin 400mg po x1 | ||
| Line 62: | Line 35: | ||
Syphilis: Pen G benzathine 2.4million U IM x1 | Syphilis: Pen G benzathine 2.4million U IM x1 | ||
===Hepatitis B=== | ===Hepatitis B=== | ||
Virus vaccine 1.0mL IM now, 1-2 months and in 4-6months if pt unimmunized | 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) | Hep B Immune Globulin for high-risk exposure (IV drug user or multiple assailants) | ||
===HIV=== | ===HIV=== | ||
Initiate within 72h (best within 36h) x 28d | Initiate within 72h (best within 36h) x 28d | ||
| Line 85: | Line 50: | ||
Lamivudine 150mg bid; | Lamivudine 150mg bid; | ||
OR | OR | ||
| Line 97: | Line 60: | ||
Emtricitabine | Emtricitabine | ||
==See Also== | ==See Also== | ||
ID: HIV Prophylaxis (Non-Occupational) | ID: HIV Prophylaxis (Non-Occupational) | ||
==Source == | ==Source == | ||
DeBonis 12/1/08 adapted from the CDC 2006 guidelines | DeBonis 12/1/08 adapted from the CDC 2006 guidelines | ||
[[Category:OB/GYN]] | [[Category:OB/GYN]] | ||
Revision as of 00:00, 29 March 2011
Workup
- Check life threats
- Don’t change, shower, etc. pt
- Consent obtained
- Contact SANE (sexual assault nurse examiner)
Risk Factors
- Risk of pregnancy without contraception 1-5%; if mid-cycle (days 14-16) risk is higher
- Risk of STD 5-10%
- Risk of HIV: consensual vaginal intercourse 0.1-0.2%; receptive anal intercourse 0.5-3%
Workup
- ABO, RPR, Hep B, HIV, EtOH, icon, Utox, G&C/wet mount
- HIV test now, 6wk, 3months, 6months
- 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