Sections

Sexual Assault

Workup

Laboratory Studies

Obtain urine or serum pregnancy tests in women of childbearing age.

Preexisting pregnancy may complicate management of coexisting injuries and is a contraindication to providing Ovral for pregnancy prevention.

Baseline screening for STDs includes the following:

Serologic tests for syphilis, hepatitis B, and HIV: HIV testing may be problematic in EDs because of laws in some states that stipulate mandatory counseling and follow-up care. However, the CDC recommends HIV screening for patients in all healthcare settings after the patient is notified that testing will be performed unless the patient declines (ie, opt-out screening).^{[11, 12]}Policy and guidelines should be established in advance with local sexual assault aftercare groups and OB/GYN services in accordance with prevailing law and CDC guidelines.
Cultures of exposed body sites (eg, oral, throat, vaginal, rectal) as appropriate: Current Centers for Disease Control and Prevention (CDC) guidelines consider Food and Drug Administration (FDA)–approved nucleic acid amplification tests an acceptable substitute for culture, as long as positive test results are confirmed by a second study.^[13] Other tests (EIA, nonamplified probes, direct fluorescent antibody tests) are not considered acceptable alternatives by the CDC because of unacceptable false-negative and false-positive result rates.
Wet mount and culture of a vaginal swab specimen to evaluate for Trichomonas vaginalis, bacterial vaginosis, and candidiasis

Recently, controversy has arisen concerning the usefulness of baseline STD testing of sexual assault victims. Opponents note the following:

Patients are offered antibiotic prophylaxis regardless of results from the preliminary screening.
The presence of STD baseline testing in the medical record invites defense attorneys to bring the victims to the witness stand, thereby opening prolonged interrogation of victims regarding their sexual histories in efforts to impeach the creditability of their stories. Many jurisdictions now forbid such inquiries into victims' personal lives, unless the victims' other sexual life experiences are somehow brought into the body of evidence before the court. These legal protections can, however, sometimes be breached, to the detriment of the victim.

These points are vigorously disputed by advocates of routine baseline testing. The CDC, in its most recent guidelines for the treatment and prevention of STDs, discusses the pros and cons of testing at some length.

Imaging Studies

Imaging studies are only indicated for evaluation of comorbid trauma.

Other Tests

To collect evidence, most hospitals have a prepackaged rape kit with the necessary equipment and detailed instructions. However, if the sexual assault victim presents 72 hours after the event, the evidence collection kit is no longer needed for legal documentation of the case.

Procedures

Colposcopy, where available, may have considerable value in documentation because it allows photographic recording of injuries. Anoscopy may be performed in male victims, and it may be combined with colposcopy in female victims.

Evidence suggests that if speculum examination is performed before toluidine blue application to the posterior fourchette (to enhance small lesions that may occur during forceful genital penetration), the speculum itself may cause small lesions that will take up the dye. These iatrogenic lesions will be seen on colposcopy. Clinicians should consider deferring speculum examination until after external colposcopy if toluidine blue is to be used.

Treatment & Management

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Author

Marian Sackey, MD Resident Physician, Department of Emergency Medicine, Louisiana State University School of Medicine in New Orleans

Marian Sackey, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents' Association, Student National Medical Association

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, American College of Emergency Physicians, American Medical Association, Council of Residency Directors in Emergency Medicine, Phi Beta Kappa, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Gil Z Shlamovitz, MD, FACEP 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

Disclosure: Nothing to disclose.

Additional Contributors

William S Ernoehazy, Jr, MD, FACEP Attending Physician, Department of Emergency Medicine, Flagler Hospital; Attending Physician, Baptist Emergency at Town Center

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

Disclosure: Nothing to disclose.

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.

Sexual Assault Workup

Laboratory Studies

Imaging Studies

Other Tests

Procedures

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