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
    • Theoretically higher risk of transmission in sexual assault than consensual due to physiological factors
    • Consensual receptive vaginal intercourse 0.1-0.2%
    • Consensual receptive anal intercourse 0.5-3%

Clinical Features

  • History of sexual exposure without consent
  • May or may not have symptoms/signs of injury

Differential Diagnosis

Genitourinary trauma

Evaluation

General

  • Check for life threats and emergent medical needs first
  • Ask patient not to change, shower, eat, or drink
  • Defer GU examination if patient consents to SANE exam
  • 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

HIV nonoccupational exposure algorithm

Other STDs


Remember to attend to patient's emotional needs as well, consider social work consult and/or offering support resources such as [Rape, Abuse & Incest National Network] 800-656-HOPE

Disposition

  • Typically outpatient

See Also

External Links

References