From the Guidelines
A comprehensive treatment plan for a sexual assault patient should prioritize both medical and psychological care, including prophylactic antibiotic treatment, emergency contraception, and psychological support, as outlined in the most recent guidelines from the Centers for Disease Control and Prevention (CDC) 1.
Initial Management
Initial management involves obtaining a detailed history, performing a thorough physical examination, and collecting forensic evidence with the patient's consent. Essential laboratory tests include:
- Pregnancy testing
- HIV
- Hepatitis B and C
- STI screening (gonorrhea, chlamydia, syphilis, and trichomoniasis)
Prophylactic Antibiotic Treatment
Prophylactic antibiotic treatment typically includes:
- Ceftriaxone 500 mg IM once for gonorrhea
- Doxycycline 100 mg orally twice daily for 7 days for chlamydia
- Metronidazole 2 g orally once for trichomoniasis
HIV Post-Exposure Prophylaxis
For HIV post-exposure prophylaxis, consider tenofovir/emtricitabine plus dolutegravir within 72 hours of exposure if risk is significant, as recommended by the CDC 1.
Emergency Contraception
Emergency contraception should be offered, such as levonorgestrel 1.5 mg orally once or ulipristal acetate 30 mg orally once, ideally within 72-120 hours of the assault.
Psychological Support
Psychological support is crucial, including crisis intervention, trauma-informed care, and referral to specialized counseling services. Follow-up care should be arranged for repeat testing, vaccination completion, and ongoing psychological support.
Follow-Up Care
Follow-up care should include a visit within 1 week of presentation to assess injury healing and to ensure that counseling has been arranged, as well as reassessment for STIs and pregnancy testing at 2 weeks, and repeat testing for syphilis and HIV at 6 weeks, 3 months, and 6 months after the assault if initial test results were negative and infection in the assailant could not be ruled out 1.
From the Research
Treatment Plan for Sexual Assault Victims
A treatment plan for a patient who has been sexually assaulted should prioritize their immediate medical needs, including treatment of injuries and prevention of unwanted pregnancy and sexually transmitted infections (STIs) 2. The plan should also address the patient's psychological and emotional well-being.
Laboratory Tests
The following laboratory tests should be ordered:
- Human immunodeficiency virus (HIV) test
- Sexually transmitted infection (STI) tests, including:
- Chlamydia
- Gonorrhea
- Hepatitis B
- Pregnancy test
Antibiotic Prophylaxis
Antibiotic prophylaxis should be considered to prevent STIs, including:
- Ceftriaxone and azithromycin for gonorrhea and chlamydia 3, 4
- Penicillin G formulations for syphilis 3
- Local prevalence of infections and resistance to antibiotics should be considered when deciding on antibiotic prophylaxis 2
Additional Considerations
- Emergency contraception should be offered to prevent unwanted pregnancy 2
- Psychosocial support and risk assessment of vulnerabilities, including self-harm or domestic violence, should be addressed and acted on depending on identified needs 2
- Follow-up care, including STI screening and HIV testing, should be scheduled 2 weeks after the initial visit, unless symptoms develop sooner 2