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Sexual Assault
Aka: Sexual Assault, Rape, Rape Management, Forcible Intercourse, Female Rape Victim, Date Rape, Alcohol and Drug Facilitated Sexual Assault, ADFSA
- See Also
- Sexual Assault of Male Victim
- Sexual Abuse in Children
- Rape Kit (Sexual Assault Kit)
- Date Rape Drug
- Definitions
- Alcohol and Drug Facilitated Sexual Assault (ADFSA)
- Forced (or surreptitious) ingestion of Alcohol or Date Rape Drug used by perpetrators to facilitate Sexual Assault
- Epidemiology
- Rape lifetime Incidence in women: 18%
- Most perpetrators are known to the victim (only 14% of rapes are by strangers)
- History
- Use the patient's exact words
- Use the phrase "alleged Sexual Assault"
- Avoid the word "Rape" (legal term, not a medical term)
- Document specific details
- Age and other identifying details about the assailant
- Date, time and location of assault
- Specific circumstances about the assault
- Include sexual contact
- Exposure to body fluids
- Restaints used by the assailant (e.g. weapons, drugs)
- Document any cleaning (bathing, douching) or clothes changing done by patient since the assault
- Obtain full gynecologic history
- Labs
- Forensic Evidence with Rape Kit
- Urine Pregnancy Test
- Vaginal and Endocervical Samples (consider repeating at 2 week)
- Gonorrhea PCR
- Chlamydia PCR
- Trichomonas
- Wet prep for sperm (motile for up to 6 hours)
- Consider Herpes Simplex Virus Testing to obtain baseline
- Serology initially and at 6, 12 and 24 weeks
- Hepatitis B Surface Antigen and Hepatitis B core IgM
- RPR for Syphilis Testing
- HIV Test
- Management
- Sexual Assault Nurse Examiners (SANE) perform these Sexual Assault forensic exams in most regions of the United States
- http://www.forensicnurses.org/
- Emergency Contraception
- Levonorgestrel 1.5 mg for 1 dose (Plan B)
- STD Prevention (perform all measures)
- Ceftriaxone 250 mg IM for 1 dose
- Metronidazole 2 g orally for 1 dose
- Azithromycin 1 g orally for 1 dose (or Doxycycline 100 mg twice daily for 7 days)
- Hepatitis B Vaccine
- CDC as of 2010 guidelines does not recommend Valacyclovir for HSV prophylaxis (insufficient evidence)
- Consider HIV Prophylaxis in high risk exposure
- See HIV Postexposure Prophylaxis
- Assess HIV risk in assailant
- Vaginal intercourse risk: 0.1 to 0.2% HIV Transmission risk
- Rectal intercourse risk: 0.5 to 3% HIV Transmission risk
- Oral risk: Low HIV Transmission risk
- Assess for degree of mucosal Trauma, bleeding and other injuries associated with higher transmission risk
- Consider contacting National Clinician's Post-exposure Prophylaxis hotline (PEPline) at 888-448-4911
- Follow-up required in 7 days if prophylaxis started
- Associated Conditions: Following Assault
- Chronic Pelvic Pain
- Chronic back pain
- Fibromyalgia
- Headaches
- Irritable Bowel Syndrome
- Sexual Dysfunction
- Somatoform Disorder
- Alcohol Abuse
- Drug Abuse
- Anxiety Disorder
- Major Depression
- Eating Disorders
- Posttraumatic Stress Disorder
- Sleep disorder
- Resources
- Sexual Assault Forensic Examiner technical assistance
- http://www.safeta.org
- Sexual Assault Nurse Examiners (SANE)
- http://www.forensicnurses.org/
- Resources
- CDC Sexual Violence Data
- https://www.cdc.gov/violenceprevention/sexualviolence/datasources.html
- References
- Luce (2010) Am Fam Physician 81(4): 489-5 [PubMed]
- Petter (1998) Am Fam Physician 58(4): 920-30 [PubMed]
- Tayara (2006) Best Pract Res Clin Obstet 20(3): 395-408 [PubMed]
- Welch (2007) BMJ 334(7604): 1154-8 [PubMed]