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How to Treat Sexual Assault?


Things to note:
  • Trauma counselling and completion of J88 forms
  • Examination under anaesthesia may be required for adequate forensic sample collection, or repair of genital tract trauma.

Medical Treatment:
Emergency contraception:
  • Levonorgestrel 1.5 mg, oral, preferably within 24 hours of event.
OR
  • Ethinyl estradiol 100 mcg plus norgestrel 1 mg, oral, 12 hourly for 2 doses
Note:
Emergency contraception can be given up to 5 days following an episode of unprotected intercourse.
STI prophylaxis
  • Cefixime, oral, 400 mg immediately as a single dose.
PLUS
  • Metronidazole, oral, 2 g, immediately as a single dose.
PLUS
  • Doxycycline 100 mg 12 hourly for 7 days.
  • In pregnancy, use: Amoxicillin, oral, 500 mg 8 hourly for 7 days.
HIV post-exposure prophylaxis (PEP)
  • PEP should be offered to survivors presenting rape within 72 hours.
  • Rape survivors who test HIV seropositive must not be given PEP.
Offer the basic two-drug PEP regimen:
  • Zidovudine, oral, 300 mg 12 hourly for 4 weeks.
AND
  • Lamivudine, oral, 150 mg 12 hourly for 4 weeks.
High-risk exposure (genital lacerations or anal intercourse), expanded three-drug regimen
ADD
  • Lopinavir / ritonavir, oral, 400/100 mg 12 hourly.
  • Zidovudine often causes nausea and headache. If zidovudine is not tolerated, switch to tenofovir (check baseline creatinine clearance as above) or stavudine.
  • Lopinavir/ritonavir often causes diarrhoea. If lopinavir/ritonavir is not tolerated switch to efavirenz.