Sexual assault

Workup

Check life threats

Don’t change, shower, etc. pt

Consent obtained

Contact SANE (sexual assault nurse examiner)

Riskfactors

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%

W/U

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