Sexual Assault Medication

Updated: Nov 28, 2018
  • Author: Marian Sackey, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Medication

Medication Summary

Medical intervention in sexual assault is focused on prevention of unwanted pregnancy and STDs. The recommendations below follow the most recent CDC guidelines, dated 2015. [13]

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

Current DOC for prophylaxis against gonorrheal infection. Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Bactericidal activity results from inhibiting cell wall synthesis by binding to 1 or more penicillin-binding proteins. Exerts antimicrobial effect by interfering with synthesis of peptidoglycan, a major structural component of the bacterial cell wall. Bacteria eventually lyse because of the ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.

Highly stable in presence of beta-lactamases and both penicillinase and cephalosporinase of gram-negative and gram-positive bacteria. Approximately 33-67% of dose is excreted unchanged in urine and remainder is secreted in bile and ultimately in feces as microbiologically inactive compounds. Reversibly binds to human plasma proteins and bindings have been reported to decrease from 95% bound at plasma concentrations < 25 mcg/mL to 85% bound at 300 mcg/mL.

Cefixime (Suprax)

In August 2012, the CDC announced changes to 2010 sexually transmitted disease guidelines for gonorrhea treatment. The Gonococcal Isolate Surveillance Project (GISP) described a decline in cefixime susceptibility among urethral N gonorrhoeae isolates in the United States during 2006-2011. Because of cefixime's lower susceptibility, new guidelines were issued that no longer recommend oral cephalosporins for first-line gonococcal infection treatment. Cefixime inhibits bacterial cell wall synthesis, and the bacteria eventually lyse because of ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.

Metronidazole (Flagyl, Metro)

Active against various anaerobic bacteria and protozoa. Appears to be absorbed into cells. Intermediate-metabolized compounds formed bind DNA and inhibit protein synthesis, causing cell death.

Azithromycin (Zithromax, Zmax)

Treats mild to moderate infections caused by susceptible strains of microorganisms. Indicated for prophylaxis of chlamydial infections of the genital tract.

Doxycycline (Morgidox, Doryx, Vibramycin, Avidoxy, Acticlate, Oracea)

Alternate to azithromycin in STD prophylaxis regimens. Broad-spectrum, synthetically derived bacteriostatic antibiotic in the tetracycline class. Almost completely absorbed, concentrates in bile, and is excreted in urine and feces as a biologically active metabolite in high concentrations.

Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Contraceptives, Oral

Class Summary

These agents are used to prevent unwanted pregnancies after sexual assault. In addition to the contraceptive listed below, the intrauterine device (IUD) copper IUD may be used. Copper IUD is the most effective method of emergency contraception. Copper enhances the cytotoxic inflammatory response within the endometrium, impairs sperm migration and viability, and lowers the chances of survival of an embryo before it reaches the uterus. It can be removed after a woman's next menstrual period or left in place for up to 10 years as an ongoing contraceptive if desired.

Levonorgestrel oral (Aftera, Econtra EZ, Fallback Solo)

Levonorgestrel can prevent pregnancy through several mechanisms: thickening of cervical mucus, inhibiting sperm passage through the uterus and sperm survival; inhibition of ovulation, from a negative feedback mechanism on the hypothalamus, which reduces secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH); altering the endometrium, which may affect implantation. 

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Progestins Receptor Modulators

Class Summary

Agents in this category may be used for emergency contraception.

Ulipristal (Ella, Logilia)

A selective progesterone receptor modulator with primarily antiprogestin activity. It can delay ovulation and appears to be effective in the advanced follicular phase, including after LH levels have begun to rise but not peaked. It is most effective as an emergency contraception up to 120 hours after intercourse.

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