Sexual Assault

Question 1

What is the recommended prophylactic antibiotic treatment for patients following sexual assault?

Answer 1

• Ceftriaxone 500 mg IM x 1 (or 1 g if >/= 150 kg)
  –AND–
• Doxycycline 100 mg PO BID x 7 days
  –AND–
• Metronidazole 500 mg PO BID x 7 days

Based on risk AND if < 72 hours post-assault:
- Zidovudine x 28 days (80% reduction in HIV)
- with follow-up testing

Question 2

What screening is recommended if patients refuse prophylactic antibiotic treatment following sexual assault?

Answer 2

• NAAT for chlamydia and gonorrhea
• Wet mount for:
  - Trichomoniasis
  - Candida
  - Bacterial vaginosis
• Serum:
  - HIV
  - Hepatitis B
  - Hepatitis C
  - Syphilis
• Consider IgG for HSV 1 and 2

Question 3

List recommended aftercare treatment for sexual assault (not including prophylactic antibiotics).

Answer 3

• Immunization:
  - Hepatitis B
  - HPV
• Empiric treatment:
  - Chlamydia
  - Gonorrhea
  - Trichomoniasis
  - Bacterial vaginosis
• Consider PrEP for HIV (Zidovudine)
• Pregnancy tests/Emergency contraception

Question 4

What is the recommended follow-up testing schedule for post-sexual assault?

Answer 4

At 1 - 2 weeks, repeat:
- Chlamydia
- Gonorrhea
- Wet mount for:
- Trichomoniasis
- Bacterial vaginosis
- Candida

Repeat serology for:
- HIV
- Hepatitis B
- Hepatitis C
- Syphilis

At:
- 6 weeks
- 3 months
- 6 months