Sexual assault

Question 1

Key aspects of sexual assault history taking:

Answer 1

• Assault: who, what, where, how, ?condom used, ?STI status of assailant.
• Legal: ?police involvement, ?collect evidence and has she changed clothes/bathed since.
• Pregnancy risk: LMP, ?contraception and consider emergency contraception.

Question 2

Key aspects of sexual assault examination:

Answer 2

• Appropriate forensic examination consent
• Complete survey for non-genital injuries
• Collect evidence: photos, DNA, STI swabs, clothing.

Question 3

Key aspects of sexual assault management:

Answer 3

• Treat immediate injuries.
• STI risk:
  
  • Screening with swabs (NAAT/HVS MCS); follow-up at 2 weeks.
  • Serology (VRDL, Hep B/C, HIV)
  • empiric antibiotic treatment
  • infectious diseases for HIV prophylaxis
  • Hep B immunisation
  • Follow-up serology 6 weeks, 3 months and 6 months.
• Pregnancy risk:
  
  • exclude pregnancy
  • offer emergency contraception (ECP or CuIUD)
  • repeat pregnancy test if misses next period.
• Emotional impact:
  
  • ACC, psychologist, victim support, close contact disclosure; may need sleeping aid.
• Legal: if consents to, involve police and MEDSAC.