see: [Dunn Sexual assault](x-devonthink-item://67A3C714-97CC-4265-8D71-E26B33476989) - life threats and physical injuries - advise patient not to change clothes or wash - history - Ix -- HIV, Hep B, Hep C, PV swabs, preg test - colposcopy for photo recording of injuries -- by forensic medical officer in secure area - [[emergency contraception]] - levonorgestrel 1.5mg state, 85% effective - disease PPx - azithromycin 1g orally + Hep B - high risk: ceftriaxone 25mg IM + Hep B Ig 400 IU - HIV PPx depending on risk - psychosocial support - evidence collection within 72H by forensic medical officer - safe place to discharge -- SW, family, rape crisis group, GP - STD follow up in 2 weeks for initial, then 3 months, 6 months for Hep C # SD PPx - risk of STDs - gonorrhoea 4% - syphilis <3% - chlamydia, trichomonas 5-15% - HIV risk - from a single sexual encounter: 1:500 -1:1000 for known seropositivity - 2-10x higher if anal - 1:5,000,000 for low-risk assailant **Treatment** (all pts) - azithromycin 1g oral - hep B vaccine - high risk cases: - ceftriaxone 250mg IM - substitute erythromycin for doxycycline if possibly pregnant - ben pen 1.8g - Hep B immunoglobulin - discuss HIV ppx with local ID if high risk: - assailant HIV positive or risk factors - anal rape - trauma and bleeding - multiple assailants