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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
Chapter 14
Prophylaxis Care after Sexual Assault
Sally Awad, MD
Adult/Adolescents
In patients who have been sexually assaulted, there are a number of pathogens that must be considered which may
result in sexually transmitted infections. Trichomoniasis, bacterial vaginosis, chlamydia, and gonorrhea are the
most frequently diagnosed infections among women who have been sexually assaulted. The presence of a sexually
transmitted infection (STI) after an assault does not necessarily imply acquisition during the assault.
As adherence to follow up visits is traditionally low, any adult/adolescent patient who presents for sexual assault
including genital, anal or oral assault with or without ejaculation should be offered prophylaxis in the emergency
department for (STIs) including gonorrhea, chlamydia and trichomoniasis. Of note, gonorrhea prophylaxis may also
provide coverage for syphilis. Prophylaxis is NOT recommended without testing in children.
According to the 2010 Centers for Disease Control (CDC) Sexually Transmitted Diseases Treatment Guidelines and
the updated 2012 revisions, the CDC recommends the following antibiotic regimen:
Recommended Prophylactic Regimens for Gonorrhea, Trichomoniasis, and Chlamydia infections
Ceftriaxone 250 mg Intramuscularly in a single dose
PLUS
Metronidazole 2 g orally in a single dose
PLUS
Azithromycin 1 g orally in a single dose
OR
Doxycycline 100 mg orally twice a day for 7 days
Avoid the use of Ceftriaxone in patients with anaphylactic reactions to penicillin.
Avoid Metronidazole use with alcohol as may cause nausea and vomiting
Avoid the use of Azithromycin in patients with allergy to erythromycin.
Avoid the use of Doxycycline in pregnant women or in children <8 years of age
Hepatitis B and human immunodeficiency virus infections (HIV) may also be transmitted through sexual assault.
As indicated, vaccination and antiretroviral administration must be considered as part of a regimen to provide
prophylaxis for patients against these potential pathogens. The hepatitis B vaccine should be administered
intramuscularly to patients not previously immunized. The first dose is given in the emergency department, the
second dose at 1–2 months and the third dose at 4–6 months. If the patient has not been immunized and the
assailant is known to have acute or active hepatitis B, the addition of hepatitis B immune globulin (HBIG) should be
considered.
HIV prophylaxis is a complex issue. Health care personnel must weigh the risk of HIV transmission to the patient
against the time since the assault occurred, the potential side effects of the medications, and the likelihood of patient
adherence to medications and follow up.
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Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Prophylaxis Care after Sexual Assault
71
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