Sexual Assault

1. See Also
   1. Sexual Abuse in Children
   2. Rape Kit (Sexual Assault Kit)
2. 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
3. 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)
   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
4. Management
   1. Emergency Contraception
   2. Consider HIV Prophylaxis in high risk exposure
      1. Assess HIV risk in assailant
      2. Assess for degree of mucosal trauma, bleeding and other injuries associated with higher transmission risk
      3. Consider contacting National Clinician's Post-Exposure Prophylaxis hotline (PEPline) at 888-448-4911
      4. Follow-up required in 7 days if prophylaxis started
   3. STD Prevention (perform all measures)
      1. Ceftriaxone 125 mg IM x1 dose
      2. Metronidazole 2 g PO x1 dose
      3. Azithromycin 1g PO x1 dose
      4. Hepatitis B Vaccine
5. Associated Conditions: Following Assault
   1. Chronic Pelvic Pain
   2. Chronic back pain
   3. Fibromyalgia
   4. Headaches
   5. Irritable Bowel Syndrome
   6. Sexual dysfunction
   7. Somatoform Disorder
   8. Alcohol Abuse
   9. Drug Abuse
   10. Anxiety Disorder
   11. Major Depression
   12. Eating Disorders
   13. Posttraumatic stress disorder
   14. Sleep disorder
6. Resources
   1. Sexual Assault Forensic Examiner technical assistance
      1. http://www.safeta.org
7. References
   1. Luce (2010) Am Fam Physician 81(4): 489-5
   2. Petter (1998) Am Fam Physician 58(4): 920-30
   3. Tayara (2006) Best Pract Res Clin Obstet 20(3): 395-408
   4. Welch (2007) BMJ 334(7604): 1154-8