Tweet of the day @drkkaggarwal: Examination of a sexually assaulted patient

10:20 am Health Care

1.    In the US, one in three women will be a victim of sexual assault during her lifetime

2.    In the US, 7-10% of sexual assault victims are male.

3.    In the US, only 10-15% of sexual assaults are reported to the police

4.    Evaluation of sexual assault victim should be performed by a trained provider.

5.    Evaluation of sexual assault victim: Do psychological assessment

6.    Evaluation of sexual assault victim: Evaluate areas of trauma; examine breasts, pelvic, anorectal areas.

7.    Evaluation of the sexual assault victim: Do colposcopy if possible, to detect genital trauma.

8.    Evaluation of the sexual assault victim: Do it as soon as possible after an assault.

9.    Evaluation of the sexual assault victim: Screening for sexually transmitted disease not necessary if prophylactic treatment is to be given.

10.  Evaluation of the sexual assault victim: Test for pregnancy testing in women of childbearing age.

11.  Evaluation of the sexual assault victim: Do baseline tests for syphilis, hepatitis B

12.  Evaluation of the sexual assault victim: Provide HIV counseling

13.  Provide empiric treatment of sexually transmitted infections if the patient has declined testing for STD.

14.  Empiric therapy for sexual assault victim: Ceftriaxone 250 mg IM for gonorrhea

15.  Empiric therapy for sexual assault victim: Azithromycin 1 gram oral stat or doxycycline 100 mg oral twice daily for 7 days for chlamydia.

16.  Empiric therapy for sexual assault victim: Metronidazole 2 grams oral stat for trichomoniasis.

17.  Empiric therapy for sexual assault victim: Hepatitis B vaccine if not been previously immunized.

18.  Empiric therapy for sexual assault victim: Prophylactic treatment for HIV is controversial.

19.  Empiric therapy for sexual assault victim: The risk of HIV is low. But most recommend treatment if can be given in < 72 hours and ideally within 4 hours.

20.  Empiric therapy for sexual assault victim: Give post coital contraception

21.  Empiric therapy for sexual assault victim: Acute crisis counseling should be offered.

22.  Sexual assault victim: Many patients experience psychological and physical symptoms over many months following the assault.

23.  Sexual assault victim:  Follow-up at 2 weeks, with psychosocial counseling, STD testing for patients who did not take empiric therapy or who have symptoms, and pregnancy testing.

24.  Sexual assault victim: Give Hepatitis B vaccine  at one and six months to complete the vaccine course ]

25.   Sexual assault victim: Repeat HIV and RPR testing at 12 and 24 weeks; some also recommend testing at six weeks.

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