Sexual assault: Difference between revisions
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*[[STD]] (5-10%) | *[[STD]] (5-10%) | ||
*[[HIV]] | *[[HIV]] | ||
**Consensual vaginal intercourse 0.1-0.2% | **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% | **Consensual receptive anal intercourse 0.5-3% | ||
==Clinical Features== | ==Clinical Features== | ||
*History of sexual exposure | *History of sexual exposure without consent | ||
*May or may not have symptoms/signs of injury | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
===General=== | ===General=== | ||
*Check for life threats first | *Check for life threats and emergent medical needs first | ||
*Ask patient not to change, shower, eat, or drink | *Ask patient not to change, shower, eat, or drink | ||
*Defer GU examination | *Defer GU examination if patient consents to SANE exam | ||
*Contact SANE (sexual assault nurse examiner), if patient consents, and police (if report not already filed and patient consents, or if required by law) | *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=== | ===Labs=== | ||
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**[[Tinidazole]] 2g orally in a single dose | **[[Tinidazole]] 2g orally in a single dose | ||
''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 www.rainn.org 800-656-HOPE'' | |||
==Disposition== | ==Disposition== | ||
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==External Links== | ==External Links== | ||
*https://www.cdc.gov/std/tg2015/sexual-assault.htm | *https://www.cdc.gov/std/tg2015/sexual-assault.htm | ||
*https://www.rainn.org/about-rainn | |||
==References== | ==References== | ||
Revision as of 18:03, 4 October 2019
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 and emergent medical needs first
- Ask patient not to change, shower, eat, or drink
- Defer GU examination if patient consents to SANE exam
- 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
- Hepatitis B post-exposure prophylaxis
- Consider HIV post-exposure prophylaxis
- Tetanus vaccine
Other 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
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 www.rainn.org 800-656-HOPE
Disposition
- Typically outpatient