Sexual assault

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

IV Prophylaxis (Non-Occupational)

Source

CDC 2006 guidelines