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==Workup==
==Workup==
#ABO, RPR, Hep B, HIV, EtOH, icon, Utox, G&C/wet mount
#ABO, RPR, Hep B, HIV, EtOH, hCG, Utox, G&C/wet mount
#HIV test now, 6wk, 3months, 6months
#HIV test now, 6wk, 3months, 6months
#CBC, Chem 10 if HIV PPx
#CBC, Chem 10 if will need HIV PPx


==Treatment==
==Treatment==
===Pregnancy===
===Pregnancy===
Yuzpe ethinyl estradiol 100macg po plus levonorgestral 0.5mg po; repeat in 12h
*Yuzpe ethinyl estradiol 100mcg po plus levonorgestral 0.5mg po; repeat in 12h
 
OR
OR
 
*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
*GC
 
**CTX 125mg IM or Cipro 500mg po x1 or Ofloxacin 400mg po x1
PLUS
*Chlam
 
**Azithromycin 1g PO x1 or Doxycyclin 100mg po bid x7d
Chlaymdia: Azithromycin 1g PO x1 or Doxycyclin 100mg po bid x7d
*Trich
 
**Metronidazole 2g PO x1 or 500mg po bid x 7d
PLUS
*Syphilis
 
**Pen G benzathine 2.4million U IM x1
Trich: Metronidazole 2g PO x1 or 500mg po bid x 7d
 
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
*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)
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
 
*Zidovudine 300mg bid or 200mg tid + Lamivudine 150mg bid
Zidovudine 300mg bid or 200mg tid
 
PLUS
 
Lamivudine 150mg bid;
 
 
OR
OR
*Tenofovir + Emtricitabine
 
Tenofovir
 
PLUS
 
Emtricitabine




Línea 65: Línea 46:


==Source ==
==Source ==
DeBonis 12/1/08 adapted from the CDC 2006 guidelines
CDC 2006 guidelines


[[Category:ID]]
[[Category:ID]]
[[Category:OB/GYN]]
[[Category:OB/GYN]]
[[Category:Trauma]]
[[Category:Trauma]]

Revisión del 07:43 5 abr 2011

Workup

  1. Check life threats
  2. Don’t change, shower, etc. pt
  3. Consent obtained
  4. Contact SANE (sexual assault nurse examiner)

Risk Factors

  1. Risk of pregnancy without contraception 1-5%; if mid-cycle (days 14-16) risk is higher
  2. Risk of STD 5-10%
  3. Risk of HIV: consensual vaginal intercourse 0.1-0.2%; receptive anal intercourse 0.5-3%

Workup

  1. ABO, RPR, Hep B, HIV, EtOH, hCG, Utox, G&C/wet mount
  2. HIV test now, 6wk, 3months, 6months
  3. CBC, Chem 10 if will need HIV PPx

Treatment

Pregnancy

  • Yuzpe ethinyl estradiol 100mcg po plus levonorgestral 0.5mg po; repeat in 12h

OR

  • Plan B levonorgestrel 0.75mg po q12h x2

STD

  • GC
    • CTX 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

  • Initiate within 72h (best within 36h) x 28d
  • Zidovudine 300mg bid or 200mg tid + Lamivudine 150mg bid

OR

  • Tenofovir + Emtricitabine


See Also

ID: HIV Prophylaxis (Non-Occupational)

Source

CDC 2006 guidelines

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