Sexual assault: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
== | ==Evaluation== | ||
===General=== | ===General=== | ||
*Check for life threats first | *Check for life threats first | ||
Revision as of 09:35, 25 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
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
References
- CDC 2006 guidelines