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%
  • Consensual receptive anal intercourse 0.5-3%

Clinical Features

• History of sexual exposure

Evaluation

General

• Check for life threats first
• Ask patient not to change, shower, eat, or drink
• Defer GU examination
• 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

• Consider emergency contraception if possibility of pregnancy
• Consider HIV post-exposure prophylaxis
• Td

Hepatitis B Post-exposure prophylaxis

• Vaccine 1.0mL IM now, 1-2 months and in 4-6months if patient unimmunized
• Immune Globulin for high-risk exposure (IV drug user or multiple assailants)

Other STDs

• Ceftriaxone 250mg IM in a single dose PLUS
• Azithromycin 1 g orally in a single dose PLUS
• Metronidazole 2 g orally in a single dose OR
• Tinidazole 2 g orally in a single dose

^Currently no PEP for Hep C

See Also

• HIV post-exposure prophylaxis
• Abuse (Nonaccidental Trauma)

References

• CDC 2006 guidelines