Sexual assault Flashcards
Needs following sexual assault can be split into 3 categories, what are they?
Immediate
Medium term
Long term
What are the forensic timescales for DNA sampling?
Digital penetration 12 hours
Oral penetration 48 hours
Anal penetration 72 hours
Vaginal penetration 7 days
What should a brief history of the sexual assault include?
Date Time Location Number of perpetators perpetrator characteristic (stranger, partner etc) Physical violence Injuries Sexual acts Ejaculation Condom use
When performing physical examination following sexual assault what should this include?
Interpretation of hymenal findings in adolescent girl (or refer to specialist)
Inspect for injury/signs of infection
- female external and internal genitalia
- male genitalia and perianal area
- oral cavity both men and women
consider proctoscopy
When should testing for chlamydia and gonorrhoea be offered post sexual assault?
Can be offered at baseline (window period should be explained)
2 weeks after sexual assault
When should testing for syphilis and BBVs be offered post sexual assault?
At baseline - can either be tested or samples saved
3 months post assault
When might prophylaxis against STIs be given post sexual assault?
If within window period
- patient may default
- patient unable to tolerate testing or re-testing/examination
- requires emergency IUD
What organisms should be prophylactically treated post sexual assault?
Consider treatment for
- gonorrhoea
- chlamydia
- trichomoniasis
What are the risk factors associated with HIV transmission at sexual assault?
Assailant from high risk group or high prevalence area High local prevalence HIV Type of assault (anal > vaginal > oral) Stranger vs known assailant Presence of other STIs Genital injuries Multiple assailants Multiple risk factors
How likely is HBV infection following sexual assault?
Very rare in UK
When should hepatitis B vaccine be given post sexual assault?
Be considered for all
Within 6 weeks of assault
Particular if high risk exposure
Patient wishes to be vaccinated
What situations may increase risk of HBV infection post sexual assault (high risk exposure)?
Assailant known to be HBV carrier Assailant other risk factors (IVDU, MSM, high prevalence area) Anal rape Trauma and bleeding Multiple assailants
When might immunoglobulin or hepatitis B vaccine NOT be appropriate following sexual assault?
Previous vaccine/immunity
Assailant is regular/longterm partner
What is the risk of pregnancy associated with rape?
5%
What are the options for emergency contraception following sexual assault?
CuIUD
Levonorgestrel 1.5mg
Ullipristal
