What tests are recommended for STD screening in a male victim of male-on-male rape?

STD Screening for Male Victims of Male-on-Male Rape

For male victims of male-on-male rape, comprehensive STD screening should include urine NAAT testing for gonorrhea and chlamydia, plus additional testing at penetration sites such as the anus, along with baseline HIV, syphilis, and hepatitis B testing.

Initial Testing Recommendations

Bacterial STI Testing

• Gonorrhea and Chlamydia:

  • Urine nucleic acid amplification tests (NAATs) 1
  • Additional testing at penetration sites, particularly the anus 1
  • Pharyngeal (throat) testing if oral penetration occurred 1

• Syphilis:

  • Baseline serum testing 1
  • Repeat testing at 6-12 weeks after assault 1

Viral Testing

• HIV:

  • Baseline testing at initial evaluation 1
  • Follow-up testing at 6 weeks, 3 months, and 6 months after assault 1

• Hepatitis B:

  • Baseline testing if vaccination status is unknown
  • Vaccination should be offered if not previously completed 1

Timing of Sample Collection

• Initial visit: All baseline testing should be performed as soon as possible after the assault
• Follow-up testing: Should be scheduled at:
  • 1-2 weeks: To assess injury healing and medication adherence
  • 6 weeks: For repeat HIV and syphilis testing
  • 3 months: For repeat HIV testing
  • 6 months: For final HIV testing 1

Important Considerations

Consent and Documentation

• Testing should be performed only with the victim's consent 1
• Positive results may indicate pre-existing infections or infections acquired during the assault 1
• Proper documentation is crucial for legal proceedings 1

HIV Post-Exposure Prophylaxis (PEP) Assessment

When considering HIV PEP (within 72 hours of assault), assess:

1. Risk of HIV infection in the assailant
2. Characteristics of the assault that might increase transmission risk
3. Time elapsed since exposure (most effective when started immediately) 1

Higher HIV risk factors include:

• Multiple perpetrators
• Known HIV-positive perpetrator(s)
• Presence of genital lesions
• Anal trauma including bleeding
• High HIV prevalence in the geographic area 1

Prophylactic Treatment

If prophylactic treatment is provided, recommended regimens include:

• Gonorrhea: Ceftriaxone 125 mg IM once (for oral/anogenital exposure) or cefixime 400 mg orally once (for anogenital only) 1
• Chlamydia: Azithromycin 1 g orally once or doxycycline 100 mg orally twice daily for 7 days 1
• Trichomoniasis: Metronidazole 2 g orally once 1

Common Pitfalls to Avoid

1. Failing to test all potential exposure sites: Remember to test the rectum and pharynx in addition to urine samples when indicated by the assault history 1

2. Overlooking follow-up testing: STIs may not be detectable immediately after assault; scheduled follow-up testing is essential 1

3. Missing the window for HIV PEP: Assessment for HIV PEP should be done immediately, as it must be started within 72 hours of exposure 1

4. Neglecting psychological support: STD screening should be part of comprehensive care that includes psychological support and counseling 1

By following these guidelines, healthcare providers can ensure appropriate STD screening and care for male victims of male-on-male rape, helping to prevent long-term health consequences and providing comprehensive support.