What is the recommended medical treatment for a male who has been sexually assaulted by another male?

Medical Management for Male Sexual Assault Victims

Male victims of sexual assault require immediate comprehensive medical care including STI prophylaxis, HIV post-exposure prophylaxis assessment, forensic evidence collection, and psychological support with referral for trauma-focused therapy. 1

Immediate Medical Assessment

• Create a supportive, non-judgmental environment for disclosure
• Perform thorough medical evaluation in a private setting
• Document all findings meticulously using direct quotes when possible
• Assess for immediate medical needs and treat accordingly

Physical Examination and Evidence Collection

• If assault occurred within 72-96 hours, advise against bathing or changing clothes until examination
• Collect forensic evidence according to local protocols
• Perform thorough examination of all penetration sites, particularly anal examination
• Document all injuries with photographs when possible 1
• Urine NAAT testing is recommended for males, with additional testing at penetration sites (especially anal) 2

STI Testing and Prophylaxis

Initial Testing

• Baseline STI testing for:
  • Gonorrhea and chlamydia (NAAT testing)
  • Trichomoniasis
  • HIV, hepatitis B, and syphilis serology 1

Prophylactic Treatment

• Empirical treatment is recommended for:
  • Chlamydia: Azithromycin 1g orally in a single dose OR Doxycycline 100mg twice daily for 7 days
  • Gonorrhea: Ceftriaxone 250mg IM in a single dose
  • Trichomoniasis: Metronidazole 2g orally in a single dose 2

HIV Post-Exposure Prophylaxis (PEP)

• Should be started as quickly as possible if indicated (within 72 hours)
• Higher risk factors include:
  • Multiple perpetrators
  • Known HIV-positive perpetrator
  • Anal trauma
  • High prevalence of HIV in the geographic area 2, 1

Hepatitis B Vaccination

• Offer hepatitis B vaccine if not previously vaccinated
• Consider HBIG if assailant is known to be HBsAg-positive 1

Follow-Up Care

Medical Follow-Up

• Schedule follow-up within 1 week to assess injury healing
• Repeat STI testing at:
  • 2 weeks post-assault
  • 6 weeks
  • 3 months
  • 6 months 2, 1

Psychological Support

• Assess for suicidal or homicidal ideation, self-harm behaviors
• Arrange trauma-focused cognitive behavioral therapy
• Provide contact information for sexual assault support services
• Address specific concerns about masculinity and sexual orientation that male victims often experience 2

Special Considerations for Male Victims

• Male victims are less likely to seek professional help than female victims (only 17.6% seek professional help) 3
• Men with physical injuries or those who experienced threats during assault are more likely to seek help 3
• Male victims often struggle with reconciling their masculine identity with the experience of being a sexual victim 4
• Directly address concerns about sexual orientation that male victims may have 2

Common Pitfalls to Avoid

1. Failing to recognize male sexual assault: About 3% of men report being victims of sexual assault, but most don't seek immediate medical attention 5

2. Not collecting appropriate forensic evidence: Ensure proper documentation and collection from all sites of potential contact

3. Overlooking psychological impact: Male victims may experience unique psychological trauma related to masculinity and identity

4. Inadequate follow-up planning: Ensure comprehensive follow-up for both physical and psychological care

5. Not addressing confidentiality concerns: Male victims may be particularly concerned about privacy and stigma

By following these guidelines, healthcare providers can deliver comprehensive, sensitive care to male victims of sexual assault, addressing both immediate medical needs and long-term physical and psychological consequences.