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Sexual Assault Treatment & Management

  • Author: William Ernoehazy, Jr, MD, FACEP; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
 
Updated: Nov 10, 2015
 

Prehospital Care

If EMS is involved in transporting the patient, their primary focus should be on stabilization of life-threatening injuries and providing emotional support for the victim. Evidence collection and crisis intervention should be handled by the ED team.

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Emergency Department Care

The responsibilities of the ED physician are more complex than in routine patients. The examiner must provide psychological support and referral to the appropriate resources, treat physical injuries, collect legal evidence, document pertinent history, perform a thorough head-to-toe physical examination, give prevention of unwanted pregnancy, and provide prevention of and screening for STDs.

Even in areas where SANE team support is readily available, the clinician must be mindful that the ED record also constitutes legal evidence. Treatment and documentation must be accurate and meticulous.

At present, CDC guidelines for postsexual assault prophylaxis are as follows[12, 13]

  • Ceftriaxone 250 mg IM in a single dose, plus azithromycin 1 g PO in a single dose, plus metronidazole 2 g PO in a single dose or tinidazole 2 g PO in a single dose.

HPV vaccination is recommended for female survivors aged 9–26 years and male survivors aged 9–21 years. For men who have sex with men (MSM) who have not received the HPV vaccine or who have been incompletely vaccinated, vaccine can be administered through age 26 years. The vaccine should be administered to sexual assault survivors at the time of the initial examination, and follow-up dose administered at 1–2 months and 6 months after the first dose.[12, 13]

Recommendations for HIV PEP are individualized according to risk. According to the NY State Department of Health, the preferred PEP regimen for sexual assault is the same as that for other types of nonoccupational exposures and occupational exposures: Tenofovir 300 mg PO daily and Emtricitabine 200 mg PO daily plus Raltegravir 400 mg PO twice daily or Dolutegravir 50 mg PO daily.[14]

Offer pregnancy prophylaxis if the pregnancy test results are negative. The current regimen of choice is 2 Ovral tablets PO in the ED, then 2 more tablets 12 hours later.

Update tetanus status when necessary.

Evaluate the patient's hepatitis B immunization status.

  • Postexposure hepatitis B vaccination, without hepatitis B immunoglobulin, should adequately protect against the hepatitis B virus.
  • Hepatitis B vaccine should be administered to sexual assault victims at the time of the initial examination if they have not been previously vaccinated. Follow-up doses of vaccine should be administered 1-2 months and 4-6 months after the first dose.

If available, offer a consultation with a sexual assault counselor in the ED. Further, refer the patient to a sexual assault center for aftercare and community resources. Given the long-term emotional and psychosocial impact of sexual assault on the victim, aftercare is vital. Community-based sexual assault centers are essential to such efforts; they serve not only as headquarters for SANE teams but also as aftercare clinics and resource centers for patients dealing with the aftermath of the assault. If such a center is not available, consultation with social services can provide access to such services that may exist in the region.

Provide reassurance and emotional support.

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Consultations

Refer to either the sexual assault center or the OB/GYN for follow up on laboratory tests and to discuss subsequent HIV surveillance and completion of hepatitis B prophylaxis (when necessary).

If the assailant is known to be HIV seropositive or is a high-risk contact, HIV prophylaxis should be considered at the time of ED contact if the patient is seen within the appropriate time window to initiate therapy. Immediate discussion with the OB/GYN and/or infectious diseases services is indicated in such cases. Risk of contracting HIV from a single sexual encounter is somewhere between 1:500 for known seropositivity and 1:5,000,000 for a low-risk assailant.

Guidelines on postexposure prophylaxis of the sexual assault victim are available from the CDC and New York State Department of Health.[13, 14]

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Contributor Information and Disclosures
Author

William Ernoehazy, Jr, MD, FACEP Medical Director, Emergency Department, Ed Fraser Memorial Hospital, Florida

William Ernoehazy, Jr, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Heather Murphy-Lavoie, MD, FAAEM, FACEP Associate Professor, Assistant Residency Director, Emergency Medicine Residency, Associate Program Director, Undersea and Hyperbaric Medicine Fellowship, Section of Emergency Medicine, Louisiana State University School of Medicine in New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine

Heather Murphy-Lavoie, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert Harwood, MD, MPH, FACEP, FAAEM Senior Physcian, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine

Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Council of Emergency Medicine Residency Directors, American College of Emergency Physicians, American Medical Association, Phi Beta Kappa, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Additional Contributors

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous editor, Charles V Pollack Jr, MD, to the development and writing of this article.

References
  1. Russell BL, Oswald DL, Kraus SW. Evaluations of sexual assault: perceptions of guilt and legal elements for male and female aggressors using various coercive strategies. Violence Vict. 2011. 26(6):799-815. [Medline].

  2. Truman, Jennifer L. and Lynn Langton. Criminal Victimization, 2014. Bureau of Justice Statistics. Available at http://www.bjs.gov/content/pub/pdf/cv14.pdf. August 27, 2015; Accessed: November 10, 2015.

  3. Ahrens CE, Aldana E. The ties that bind: understanding the impact of sexual assault disclosure on survivors' relationships with friends, family, and partners. J Trauma Dissociation. 2012 Mar. 13(2):226-43. [Medline].

  4. Avegno J, Mills TJ, Mills LD. Sexual assault victims in the emergency department: analysis by demographic and event characteristics. J Emerg Med. 2009 Oct. 37(3):328-34. [Medline].

  5. Luce H, Schrager S, Gilchrist V. Sexual assault of women. Am Fam Physician. 2010 Feb 15. 81(4):489-95. [Medline].

  6. Vagi KJ, O'Malley Olsen E, Basile KC, Vivolo-Kantor AM. Teen Dating Violence (Physical and Sexual) Among US High School Students: Findings From the 2013 National Youth Risk Behavior Survey. JAMA Pediatr. 2015 May. 169 (5):474-82. [Medline].

  7. Jones JS, Rossman L, Diegel R, Van Order P, Wynn BN. Sexual assault in postmenopausal women: epidemiology and patterns of genital injury. Am J Emerg Med. 2009 Oct. 27(8):922-9. [Medline].

  8. Cunningham N. Sexual assault consultations - from high risk to high reliability. J Forensic Leg Med. 2012 Feb. 19(2):53-9. [Medline].

  9. [Guideline] Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006 Sep 22. 55:1-17; quiz CE1-4. [Medline].

  10. Chacko L, Ford N, Sbaiti M, Siddiqui R. Adherence to HIV post-exposure prophylaxis in victims of sexual assault: a systematic review and meta-analysis. Sex Transm Infect. 2012 Feb 13. [Medline].

  11. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17. 59:1-110. [Medline]. [Full Text].

  12. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5. 64 (RR-03):1-137. [Medline].

  13. [Guideline] CDC. 2015 Sexually Transmitted Diseases Treatment Guidelines. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/std/tg2015/default.htm. June 4, 2015; Accessed: November 10, 2015.

  14. [Guideline] New York State Department of Health Aids Institute. HIV prophylaxis for victims of sexual assault. HIV Clinical Resource. Available at http://www.hivguidelines.org/wp-content/uploads/2014/10/hiv-prophylaxis-for-victims-of-sexual-assault.pdfxis-following-non-occupational-exposure.pdf. October 28, 2014; Accessed: November 10, 2015.

  15. Office on Violence Against Women. National Protocol for Sexual Assault Medical Forensic Examinations (Adults/Adolescents), 2nd ed. US Dept of Justice. Apr 2013. Available at https://www.ncjrs.gov/pdffiles1/ovw/241903.pdf. Accessed: May 8 2013.

  16. Herman AO. Updated Guidelines Issued for Medical Exams in Cases of Sexual Assault. Physician’s First Watch. Apr 26 2013. Available at http://firstwatch.jwatch.org/cgi/content/full/2013/426/1. Accessed: May 8 2013.

  17. US Dept of Justice. Justice Department Releases Updated Protocol To Improve Standards for Responding to Rape and Sexual Assault. Apr 24 2013. Available at http://www.justice.gov/opa/pr/2013/April/13-ag-466.html. Accessed: May 8 2013.

  18. Braun GR. Sexual assault. Emergency Medicine: Concepts and Clinical Practice. 3rd ed. St. Louis: Mosby-Year Book; 1992. 2003-12.

  19. Ciancone AC, Wilson C, Collette R, et al. Sexual Assault Nurse Examiner programs in the United States. Ann Emerg Med. 2000 Apr. 35(4):353-7. [Medline].

  20. da Silva DA, Goes AC, de Carvalho JJ, de Carvalho EF. DNA typing from vaginal smear slides in suspected rape cases. Sao Paulo Med J. 2004 Mar 4. 122(2):70-2. [Medline].

  21. Das S, Huengsberg M. An audit on the management of female victims of sexual assault attending a genitourinary medicine clinic. Int J STD AIDS. 2004 Jul. 15(7):484-5. [Medline].

  22. Elliott DM, Mok DS, Briere J. Adult sexual assault: prevalence, symptomatology, and sex differences in the general population. J Trauma Stress. 2004 Jun. 17(3):203-11. [Medline].

  23. Ernst AA, Green E, Ferguson MT, et al. The utility of anoscopy and colposcopy in the evaluation of male sexual assault victims. Ann Emerg Med. 2000 Nov. 36(5):432-7. [Medline].

  24. Higgins SD, Schwartz GR. The sexually assaulted patient. Sexual assault evidence collection protocol, Office of the Attorney General. Principles and Practice of Emergency Medicine. 3rd ed. Williams & Wilkins; 1992. 2418-31.

  25. Humphrey JA, White JW. Womens' vulnerability to sexual assault from adolescence to young adulthood. J Adolesc Health. 2000 Dec. 27(6):419-24. [Medline].

  26. Jones JS, Dunnuck C, Rossman L, et al. Significance of toluidine blue positive findings after speculum examination for sexual assault. Am J Emerg Med. 2004 May. 22(3):201-3. [Medline].

  27. Kenworthy T, Adams CE, Bilby C, et al. Psychological interventions for those who have sexually offended or are at risk of offending. Cochrane Database Syst Rev. 2004. CD004858. [Medline].

  28. Kintz P, Villain M, Ludes B. Testing for the undetectable in drug-facilitated sexual assault using hair analyzed by tandem mass spectrometry as evidence. Ther Drug Monit. 2004 Apr. 26(2):211-4. [Medline].

  29. Linden JA, Oldeg P, Mehta SD, et al. HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital. Acad Emerg Med. 2005 Jul. 12(7):640-6. [Medline].

  30. Littel, K. Sexual Assault Nurse Examiner (SANE) Programs: Improving the Community Response to Sexual Assault Victims. US Department of Justice, Office of Justice Programs, Office for Victims of Crime. April 2001. Available at http://www.ojp.usdoj.gov/ovc/publications/bulletins/sane_4_2001/welcome.html.

  31. Mancino P, Parlavecchio E, Melluso J, et al. Introducing colposcopy and vulvovaginoscopy as routine examinations for victims of sexual assault. Clin Exp Obstet Gynecol. 2003. 30(1):40-2. [Medline].

  32. Rand M, Catalano S. Criminal Victimization, 2006. U.S. Department of Justice, Bureau of Justice Statistics. Dec 2007. Available at http://www.ojp.usdoj.gov/bjs/abstract/cv06.htm.

  33. Reznic MF, Nachman R, Hiss J. Penile lesions -- reinforcing the case against suspects of sexual assault. J Clin Forensic Med. 2004 Apr. 11(2):78-81. [Medline].

  34. Sachs CJ. How To Convict A Rapist: Sexual Assault Response Teams. ACEP Scientific Assembly Proceedings. 1999.

  35. Sievers V, Murphy S, Miller JJ. Sexual assault evidence collection more accurate when completed by sexual assault nurse examiners: Colorado's experience. J Emerg Nurs. 2003 Dec. 29(6):511-4. [Medline].

  36. Stermac L, Del Bove G, Addison M. Stranger and acquaintance sexual assault of adult males. J Interpers Violence. 2004 Aug. 19(8):901-15. [Medline].

  37. Testa M, Vanzile-Tamsen C, Livingston JA. The role of victim and perpetrator intoxication on sexual assault outcomes. J Stud Alcohol. 2004 May. 65(3):320-9. [Medline].

 
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