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

Differential Diagnosis

Genitourinary trauma

• Bladder trauma
• Urethral trauma
• Testicular trauma
• Penile trauma
• Vaginal trauma
• Sexual assault
• Child abuse

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
• Hepatitis B post-exposure prophylaxis
• Consider HIV post-exposure prophylaxis
• Tetanus vaccine

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

There is currently no PEP for Hep C

Disposition

• Typically outpatient

See Also

• HIV post-exposure prophylaxis
• Child abuse
• Occupational exposure

References

• CDC 2006 guidelines

Authors

Ross Donaldson