Sexual assault: Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) |
||
| Line 34: | Line 34: | ||
*Consider [[emergency contraception]] if possibility of pregnancy | *Consider [[emergency contraception]] if possibility of pregnancy | ||
*Consider [[HIV post-exposure prophylaxis]] | *Consider [[HIV post-exposure prophylaxis]] | ||
*Td | |||
===Hepatitis B=== | ===Hepatitis B Post-exposure prophylaxis=== | ||
*Vaccine 1.0mL IM now, 1-2 months and in 4-6months if patient unimmunized | *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) | *Immune Globulin for high-risk exposure (IV drug user or multiple assailants) | ||
| Line 44: | Line 45: | ||
*[[Metronidazole]] 2 g orally in a single dose OR | *[[Metronidazole]] 2 g orally in a single dose OR | ||
*[[Tinidazole]] 2 g orally in a single dose | *[[Tinidazole]] 2 g orally in a single dose | ||
^Currently no PEP for Hep C | |||
==See Also== | ==See Also== | ||
Revision as of 19:58, 12 July 2016
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
Differential Diagnosis
Diagnosis
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 250 mg 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
References
- CDC 2006 guidelines