From the Guidelines
Management of a sexual assault victim 3 weeks after the incident in an urgent care setting should prioritize comprehensive care addressing both physical and psychological needs, with a focus on STI testing, mental health support, and referral to specialized services. When managing a sexual assault victim 3 weeks after the incident, it is essential to begin with a trauma-informed approach, obtaining consent before examination and providing a private, safe environment [@1@]. A complete medical evaluation should be performed, though forensic evidence collection is typically not useful after 3 weeks.
Key Considerations
- STI testing should be conducted for gonorrhea, chlamydia, syphilis, HIV, hepatitis B, and hepatitis C, as the risk of infection is still present [@1@].
- Post-exposure prophylaxis for HIV is not indicated at this point as it must be started within 72 hours of exposure.
- Emergency contraception is also not indicated after 3 weeks.
- Treat any diagnosed STIs according to current guidelines.
- For psychological support, provide crisis intervention, validate the patient's experience, and refer to specialized sexual assault services and mental health professionals, such as those found through RAINN (Rape, Abuse & Incest National Network) [@1@].
Follow-up Care
- Follow-up care should include repeat STI testing in 2-4 weeks, pregnancy testing if applicable, and continued mental health support.
- Many survivors experience PTSD, depression, and anxiety following assault, making psychological care as important as physical treatment [@1@].
- Reporting to law enforcement should be discussed but remains the patient's choice in most jurisdictions for adult victims. It is crucial to document all findings thoroughly, including the patient's account of the assault and any physical or psychological symptoms, to ensure comprehensive care and support [@1@].
From the Research
Management of Sexual Assault in Adults 3 Weeks After Assault
- The management of sexual assault in adults involves addressing medical, safety, and psychosocial concerns 1.
- A thorough medical evaluation is essential to identify and treat any injuries or infections, including sexually transmitted infections (STIs) 2.
- The initial assessment and response to a disclosure of sexual assault is an important opportunity to address medical, safety, and psychosocial concerns, and to provide the option of a forensic medical exam 1.
Diagnosis and Treatment of Sexually Transmitted Infections
- STIs are a significant concern in sexual assault cases, and prompt diagnosis and treatment are essential to prevent long-term complications 2.
- The Centers for Disease Control and Prevention (CDC) recommends ceftriaxone monotherapy for the treatment of gonorrhea, and doxycycline for the treatment of chlamydia 3, 4.
- Other STIs, such as syphilis, trichomoniasis, and genital herpes, require specific treatments, and a thorough evaluation is essential to determine the appropriate treatment regimen 2, 4.
Time to Presentation and Delayed Care
- Delayed presentation to care after sexual assault can be associated with adverse consequences for the survivor, including increased risk of STIs and other complications 5.
- Factors associated with delayed presentation include assault by a known assailant, and public health interventions can inform strategies to reduce delayed care 5.
Urgent Care Considerations
- Urgent care providers should be aware of the importance of prompt diagnosis and treatment of STIs, as well as the need for a thorough medical and psychosocial evaluation 1, 2.
- Collaboration with public health departments and other healthcare providers is essential to ensure comprehensive care and follow-up for survivors of sexual assault 4.