What is the appropriate treatment for survivors of chronic rape in adulthood?

Treatment for Survivors of Chronic Rape in Adulthood

The comprehensive treatment for adult survivors of chronic rape must include immediate medical care, STI prophylaxis, emergency contraception when applicable, psychological support with trauma-focused cognitive behavioral therapy, and ongoing follow-up care to address both physical and mental health consequences. 1

Immediate Medical Care

Physical Examination and Documentation

• Conduct a thorough examination for injuries (genital and non-genital)
• Document findings using imaging systems (photo/video) when possible
• Collect forensic evidence if within 72 hours of most recent assault
• Avoid asking victims to bathe/shower, change clothes, eat/drink, or urinate/defecate before examination 1

Laboratory Testing

• NAAT testing for gonorrhea and chlamydia at all sites of penetration
• Testing for trichomoniasis, bacterial vaginosis, and candidiasis (especially with symptoms)
• Baseline serum testing for HIV, hepatitis B, and syphilis
• Pregnancy testing for women of reproductive age 1

Prophylactic Treatment

STI Prophylaxis (Recommended Regimen)

• Ceftriaxone 250 mg IM in a single dose, PLUS
• Azithromycin 1 g orally in a single dose, PLUS
• Metronidazole 2 g orally in a single dose (or Tinidazole 2 g orally) 1

Emergency Contraception

• Offer to all women who could become pregnant
• Levonorgestrel (preferred): both tablets at once rather than 12 hours apart
• Baseline pregnancy test before administration 1

HIV Post-Exposure Prophylaxis (PEP)

• Consider within 72 hours based on risk assessment
• Higher risk factors: multiple perpetrators, known HIV-positive perpetrator, presence of genital lesions, anal trauma 1, 2

Hepatitis B Prevention

• Postexposure vaccination if not previously vaccinated
• Add HBIG if assailant known to be HBsAg-positive
• Follow-up doses at 1-2 and 4-6 months 1

HPV Vaccination

• Recommended for females through age 26 years and males through age 21 years
• Follow-up doses at 1-2 months and 6 months 1

Psychological Support

Immediate Intervention

• Address psychological trauma of rape trauma syndrome and PTSD (occurs in up to 80% of victims)
• Screen for suicidal ideation and self-harm behaviors
• Provide initial psychological support and appropriate referrals 1

Long-term Treatment

• Trauma-focused cognitive behavioral therapy has shown effectiveness 1, 3
• Referral to sexual assault care centers and specialized mental health professionals
• Consider psychotropic medications when indicated for PTSD, depression, or anxiety 1

Follow-up Care

Medical Follow-up

• 1-week follow-up to assess injury healing and ensure counseling is arranged
• 2-week follow-up for pregnancy testing and medication adherence assessment
• Repeat STI testing: syphilis and HIV at 6 weeks, 3 months, and 6 months 1

Safety Assessment

• Evaluate immediate safety concerns related to perpetrators
• Ask directly about threats, fears, and perpetrator's history of violence/access to weapons 1
• Connect with appropriate social services and legal advocacy when needed

Special Considerations for Male Victims

• Address concerns about sexual orientation and gender identity
• Ensure testing of all potential exposure sites (anal, oral)
• Provide same STI prophylaxis as female victims
• Offer hepatitis B vaccination and HIV PEP when indicated 1, 2

Common Pitfalls to Avoid

• Low follow-up rates: Only 21% of rape victims seek medical care; compliance with follow-up is poor 4, 1
• Secondary victimization: Avoid practices that make survivors feel revictimized during medical care 5
• Overlooking psychological impact: PTSD, depression, and anxiety are common and require specific treatment 1
• Missing the window for prophylaxis: HIV PEP must be started within 72 hours; emergency contraception is most effective when given early 1
• Inadequate documentation: Proper documentation is crucial for both medical care and potential legal proceedings 1

Funding Considerations

Under some circumstances, funding for tests and treatments may be available through the Victims of Crime Act, which can help alleviate financial barriers to receiving comprehensive care 1.