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
  • Consensual vaginal intercourse 0.1-0.2%
  • Receptive anal intercourse 0.5-3%

Workup

General

• Check life threats
• Don’t change, shower, etc. pt
• Defer GU examination
• Consent obtained
• Contact SANE (sexual assault nurse examiner) and Local Police (if report not already filed)

Labs

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

Treatment

• Consider emergency contraception if possibility of pregnancy

STD

• GC
  • Ceftriaxone 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

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

OR

• Tenofovir + Emtricitabine

See Also

• HIV Prophylaxis (Non-Occupational)
• Abuse (Nonaccidental Trauma)

Source

• CDC 2006 guidelines