Sexual assault: Difference between revisions
ClaireLewis (talk | contribs) |
(Updated sexual assault PEP recommendations (HIV PEP page stated give PEP if < 36 hrs since exposure)) |
||
| Line 23: | Line 23: | ||
==Evaluation== | ==Evaluation== | ||
===General=== | ===General=== | ||
*Check for life threats | *Check for life threats, emergent medical needs, and injuries first | ||
*Ask patient not to change, shower, eat, or | *If patient consents to forensic exam after medical evaluation | ||
*Defer GU examination if patient consents to SANE exam | **Ask patient not to change, shower, eat, drink, or wash hands | ||
*Contact SANE (sexual assault nurse examiner) | **Do not give wet wipe and ask patient not to wipe when giving urine sample. Collect dirty catch urine | ||
**Defer GU examination if patient consents to SANE (sexual assault nurse examiner) exam | |||
*Contact SANE (sexual assault nurse examiner) and police (if report not already filed and patient consents, or if required by law) | |||
===Labs=== | ===Labs=== | ||
*Pregnancy test | *Pregnancy test | ||
*Rapid [[HIV]] | *Rapid [[HIV]] | ||
* | *Hepatitis panel | ||
*GC/chlamydia, if not collected by SANE | **Hepatitis B surface antigen | ||
* | **Hepatitis C viral load | ||
*RPR | |||
*Urine GC/chlamydia, if not collected by SANE | |||
*If considering HIV PEP, need baseline labs | |||
**CBC | |||
**Chemistry | |||
**LFTs | |||
==Management== | ==Management== | ||
*Consider [[emergency contraception]] if possibility of pregnancy | *Consider [[emergency contraception]] if possibility of pregnancy | ||
=== | ===Empiric Antibiotics for [[STDs]]=== | ||
*[[Ceftriaxone]] 250mg IM in a single dose '''AND''' | *[[Ceftriaxone]] 250mg IM in a single dose '''AND''' | ||
*[[Azithromycin]] 1g orally in a single dose '''AND''' | *[[Azithromycin]] 1g orally in a single dose '''AND''' | ||
*[[Metronidazole]] 2g orally in a single dose '''OR'' | *[[Metronidazole]] 2g orally in a single dose '''OR''' | ||
**[[Tinidazole]] 2g orally in a single dose | **[[Tinidazole]] 2g orally in a single dose | ||
*[[HIV post-exposure prophylaxis]] | |||
[[File:Nonoccupational HIV algorithm.png|thumb|HIV nonoccupational exposure algorithm]] | |||
**PEP recommended as soon as possible if <= 72 hours since exposure AND | |||
***Assailant HIV positive | |||
***Assailant HIV status unknown, but patient's mucous membranes or non-intact skin exposed to blood, semen, vaginal secretions, or bloody body fluids | |||
===Vaccines=== | |||
*[[Tetanus vaccine]] | |||
*[[Hepatitis B post-exposure prophylaxis]] | |||
**Even if patient is vaccinated, CDC recommends giving HBV vaccine booster shot, preferably within 24 hours of exposure | |||
*CDC recommends HPV vaccine for female patients age 9-26 and male patients 9-21 if patient has not already completed series of 3 vaccines | |||
;''Remember to attend to patient's emotional needs as well, consider social work consult and/or offering support resources such as [[https://www.rainn.org/ Rape, Abuse & Incest National Network]] 800-656-HOPE'' | ;''Remember to attend to patient's emotional needs as well, consider social work consult and/or offering support resources such as [[https://www.rainn.org/ Rape, Abuse & Incest National Network]] 800-656-HOPE'' | ||
Revision as of 22:08, 24 January 2020
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
- Urinary system
- Genital
- Other
- Child abuse
- Pelvic fracture (often accompanies)
- Sexual assault
Evaluation
General
- Check for life threats, emergent medical needs, and injuries first
- If patient consents to forensic exam after medical evaluation
- Ask patient not to change, shower, eat, drink, or wash hands
- Do not give wet wipe and ask patient not to wipe when giving urine sample. Collect dirty catch urine
- Defer GU examination if patient consents to SANE (sexual assault nurse examiner) exam
- Contact SANE (sexual assault nurse examiner) and police (if report not already filed and patient consents, or if required by law)
Labs
- Pregnancy test
- Rapid HIV
- Hepatitis panel
- Hepatitis B surface antigen
- Hepatitis C viral load
- RPR
- Urine GC/chlamydia, if not collected by SANE
- If considering HIV PEP, need baseline labs
- CBC
- Chemistry
- LFTs
Management
- Consider emergency contraception if possibility of pregnancy
Empiric Antibiotics for STDs
- Ceftriaxone 250mg IM in a single dose AND
- Azithromycin 1g orally in a single dose AND
- Metronidazole 2g orally in a single dose OR
- Tinidazole 2g orally in a single dose
- HIV post-exposure prophylaxis
- PEP recommended as soon as possible if <= 72 hours since exposure AND
- Assailant HIV positive
- Assailant HIV status unknown, but patient's mucous membranes or non-intact skin exposed to blood, semen, vaginal secretions, or bloody body fluids
- PEP recommended as soon as possible if <= 72 hours since exposure AND
Vaccines
- Tetanus vaccine
- Hepatitis B post-exposure prophylaxis
- Even if patient is vaccinated, CDC recommends giving HBV vaccine booster shot, preferably within 24 hours of exposure
- CDC recommends HPV vaccine for female patients age 9-26 and male patients 9-21 if patient has not already completed series of 3 vaccines
- 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