II. History

  1. Use the patient's exact words
  2. Use the phrase "alleged Sexual Assault"
    1. Avoid the word "Rape" (legal term, not a medical term)
  3. Document specific details
    1. Age and other identifying details about the assailant
    2. Date, time and location of assault
    3. Specific circumstances about the assault
      1. Include sexual contact
      2. Exposure to body fluids
    4. Restaints used by the assailant (e.g. weapons, drugs)
  4. Document any cleaning (bathing, douching) or clothes changing done by patient since the assault
  5. Obtain full gynecologic history

III. Labs

  1. Forensic Evidence with Rape Kit
  2. Urine Pregnancy Test
  3. Vaginal Samples (consider repeating at 2 week)
    1. Gonorrhea Culture
    2. Chlamydia culture
    3. Trichomonas
    4. Wet prep for sperm (motile for up to 6 hours)
    5. Consider Herpes Simplex Virus Testing to obtain baseline
  4. Serology initially and at 6, 12 and 24 weeks
    1. Hepatitis B Surface Antigen and Hepatitis B core IgM
    2. RPR for Syphilis Testing
    3. HIV Test

IV. Management

  1. Sexual Assault Nurse Examiners (SANE) perform these Sexual Assault forensic exams in most regions of the United States
    1. http://www.forensicnurses.org/
  2. Emergency Contraception
    1. Levonorgestrel 1.5 mg for 1 dose (Plan B)
  3. STD Prevention (perform all measures)
    1. Ceftriaxone 250 mg IM for 1 dose
    2. Metronidazole 2 g orally for 1 dose
    3. Azithromycin 1 g orally for 1 dose (or Doxycycline 100 mg twice daily for 7 days)
    4. Hepatitis B Vaccine
    5. CDC as of 2010 guidelines does not recommend Valacyclovir for HSV prophylaxis (insufficient evidence)
  4. Consider HIV Prophylaxis in high risk exposure
    1. See HIV Postexposure Prophylaxis
    2. Assess HIV risk in assailant
      1. Vaginal intercourse risk: 0.1 to 0.2% HIV Transmission risk
      2. Rectal intercourse risk: 0.5 to 3% HIV Transmission risk
      3. Oral risk: Low HIV Transmission risk
    3. Assess for degree of mucosal Trauma, bleeding and other injuries associated with higher transmission risk
    4. Consider contacting National Clinician's Post-exposure Prophylaxis hotline (PEPline) at 888-448-4911
    5. Follow-up required in 7 days if prophylaxis started

VI. Resources

  1. Sexual Assault Forensic Examiner technical assistance
    1. http://www.safeta.org
  2. Sexual Assault Nurse Examiners (SANE)
    1. http://www.forensicnurses.org/

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Forcible intercourse (C0034668)

Definition (MSH) Unlawful sexual intercourse without consent of the victim.
Definition (CSP) unlawful sexual intercourse without consent of the victim.
Concepts Social Behavior (T054)
MSH D011902
ICD9 E960.1
SnomedCT 158087006, 22439003, 248111006
English Forcible intercourse, Rape, Rapes, rapes, raped, rape, Rape (intercourse), Rape - assault, Forcible intercourse (finding), Rape - assault (finding), Forcible intercourse (event), Rape - assault (event)
Spanish violación (evento), violación - agresión (evento), violación - agresión (hallazgo), violación (hallazgo), vejación, relación sexual forzada, violación - agresión, violación, Violación
Dutch verkrachting, Verkrachting
Portuguese Violação, Estupro
Japanese 強姦, ゴウカン
Swedish Våldtäkt
Czech znásilnění, Znásilnění, stuprum
Finnish Raiskaus
Russian IZNASILOVANIE, POLOVOE NASILIE, ИЗНАСИЛОВАНИЕ, ПОЛОВОЕ НАСИЛИЕ
Croatian SILOVANJE
Polish Gwałt
Hungarian Megerőszakolás
Norwegian Voldtekt
French Viol
German Vergewaltigung
Italian Stupro

Ontology: Sexual assault (C0237236)

Definition (MEDLINEPLUS)

Sexual assault is any sexual activity to which you haven't freely given your consent. This includes completed or attempted sex acts that are against your will. Sometimes it can involve a victim who is unable to consent. It also includes abusive sexual contact. It can happen to men, women or children.

The attacker can be anyone - a current or former partner, a family member, a person in position of power or trust, a friend, an acquaintance, or a stranger.

Sexual assault can affect your health in many ways. It can lead to long-term health and emotional problems. It is important to seek help if you have been assaulted. First, get to a safe place. Then dial 911 or go to a hospital for medical care. You may want to have counseling to deal with your feelings. The most important thing to know is that the assault was not your fault.

Centers for Disease Control and Prevention

Concepts Mental or Behavioral Dysfunction (T048)
SnomedCT 422608009, 219179003, 248110007
Spanish ataque sexual (evento), ataque sexual (hallazgo), agredido sexualmente, agredido sexualmente (hallazgo), Agresión sexual, ataque sexual
English Sexual assault (finding), Sexual assault, assaulted sexually, Attack(s);sexual, sexual assault, sexual assaults, assault sexual, assault sexually, Sexual Assault, Sexual assault (event)
French Assaut sexuel
Dutch seksuele aanranding
Portuguese Violência sexual
German sexueller Uebergriff
Italian Attacco sessuale
Japanese セイテキボウコウ, 性的暴行
Czech Pokus o znásilnění
Hungarian Nemi erőszak