Domestic violence

Question 1

How do you screen for interpersonal or domestic violence

Answer 1

“I screen all my pts at least annually during their annual exams and throughout OB care.

I use a brief validated screening tool such as HITS or Abuse Assessment screen in pregnancy

If a potential issue is identified, I will engage my pt with local resources or community”

• Assess for immediate safety, assist with safety plan, offer a private call, and place numbers and brochures in bathrooms

Question 2

How do you screen for sexual assault

Answer 2

SAVE

S: screen all pts
A: ask direct question in nonjudgmental way
V: validate patient
E: evaluate, educate, refer

Question 3

How do you evaluate for rape

Answer 3

SANE or SAFE by specialized provider

Labs:
NAATs for GC/Cl/Trich
- oral, sites of penetration, vagina, rectal, urine
Blood testing
- pregnancy
- STD panel– syph, Hep B and C, HIV

Post eval
- Tx of injuries, prevention of pregnancy, STI ppx, referral for support, repeat STI testing

Question 4

What are emergency contraception options

Answer 4

Copper IUD within 5 days
Levonogestrol 52mg IUD within 5 days
Ulipristal 30mg single dose within 5 days (progesterone agonist/antogonist)

Within 3 days:
Levonogestrel 1.5mg (plan B) one tablet
Levonogestrel 0.75mg 1 tablet BID
Combined OCPs
- 100mcg Estrogen and 0.5mg levonogestrel x2 doses 12 hrs apart

Mifepristone– not in US

Question 5

What are STI ppx recommendations

Answer 5

Standard tx protocol:
Ceftriaxone 500mg IM x1 (gonorrhea)
Doxycycline 100mg PO BID x7 days (chlamydia)
Metronidazole 500mg PO BID x7 days (trichomonas)
Offer Hep B vaccine initial dose
Offer HPV vaccine initial dose
HIV risk assessment, consider PEP