What are the recommended prophylactic treatments for Sexually Transmitted Diseases (STDs)?

Prophylactic Treatment for Sexually Transmitted Diseases (STDs)

The recommended prophylactic regimen for STDs after sexual assault includes ceftriaxone 125 mg IM in a single dose, metronidazole 2 g orally in a single dose, and azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days. 1

Post-Exposure Prophylaxis After Sexual Assault

Sexual assault victims should receive comprehensive prophylactic treatment due to the difficulty in ensuring follow-up and to provide reassurance. The recommended regimen targets multiple common STDs:

1. Bacterial STDs:

   • Ceftriaxone 125 mg IM (single dose) for gonorrhea
   • PLUS Azithromycin 1 g orally (single dose) OR Doxycycline 100 mg orally twice daily for 7 days for chlamydia
   • PLUS Metronidazole 2 g orally (single dose) for trichomoniasis and bacterial vaginosis

2. Hepatitis B:

   • Hepatitis B vaccination (without HBIG) should be administered at the initial examination
   • Follow-up doses at 1-2 months and 4-6 months after the first dose 1

3. HIV:

   • Risk assessment for HIV transmission should be conducted
   • Consider antiretroviral post-exposure prophylaxis based on risk factors

Preventive Measures for STDs

Barrier Methods

Consistent and correct condom use is one of the most effective methods for preventing STDs:

• Male Condoms:

  • Use a new condom with each act of sexual intercourse
  • Put on condom when penis is erect and before any genital contact
  • Ensure no air is trapped in the tip
  • Use water-based lubricants only with latex condoms
  • Hold condom against base of penis during withdrawal 1

• Female Condoms:

  • Laboratory studies show effectiveness as a mechanical barrier to viruses
  • Should be considered when male condoms cannot be used appropriately 1

Vaccination

Preexposure vaccination is highly effective for preventing certain STDs:

• Hepatitis B Vaccine:

  • Recommended for all unvaccinated patients being evaluated for STDs 1

• Hepatitis A Vaccine:

  • Recommended for men who have sex with men and people who use illegal drugs 1

Behavioral Counseling

Effective prevention messages should be tailored to the patient's specific risk factors:

• Both partners should get tested for STDs, including HIV, before initiating sexual intercourse
• Abstinence from sexual activity if STD-related symptoms develop
• If choosing to have intercourse with a partner whose infection status is unknown or who is infected with HIV/STDs, use a new condom with each act 1

Special Considerations

Follow-Up After Sexual Assault

• Examination for STDs should be repeated 2 weeks after assault if prophylactic treatment was not provided
• Serologic tests for syphilis and HIV should be repeated at 6,12, and 24 weeks after assault if initial results were negative 1

Injection Drug Users

For people who inject drugs, prevention messages should include:

• Enrollment in drug treatment programs
• Never sharing injection equipment
• Obtaining clean needles when legally available
• Cleaning equipment with bleach and water if sharing cannot be avoided 1

Common Pitfalls and Caveats

1. Incomplete prophylaxis: Failing to address all potential STDs after sexual assault can lead to undetected infections and complications.

2. Poor follow-up: Even with prophylactic treatment, follow-up testing is essential to detect any infections that may have been acquired.

3. Inconsistent condom use: Condom failure usually results from inconsistent or incorrect use rather than breakage. Proper education on correct condom use is essential.

4. Oil-based lubricants: Using petroleum jelly, mineral oil, or other oil-based products with latex condoms can weaken the latex and increase risk of breakage.

5. Reliance on non-barrier contraceptives: Methods like oral contraceptives, implants, or sterilization provide no protection against STDs. Patients using these methods should be counseled on condom use for STD prevention.

The effectiveness of prophylactic regimens in preventing STDs after sexual assault has not been fully evaluated in clinical trials, but the recommended approach addresses the most common pathogens and provides reassurance to patients during a traumatic time 1.