Sexual assault

T74.2 + (Y05.99)

INVESTIGATIONS

Urine pregnancy test.
Blood for:

  • Syphilis serology,
  • HIV, and
  • Hepatitis B if no history of previous Hep B immunisation.

GENERAL MEASURES

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

MEDICINE TREATMENT

Emergency contraception: (Z29.8)

  • Levonorgestrel 1.5 mg, oral, preferably within 24 hours of event.

Note: Emergency contraception (EC) can be given up to 5 days following an episode of unprotected intercourse.

LoEI [29]

CAUTION

Emergency contraceptive tablets must be taken as soon as possible, preferably within 72 hours of unprotected intercourse, and not later than 5 days.
Enzyme inducers (including efavirenz, carbamazepine) cause a significant reduction in LNG concentrations. Women on these medicines should preferably have copper IUCD EC inserted or alternatively double the dose of levonorgestrel, because of significant reduction of LNG EC.
Women >80 kg or BMI ≥30 should be given twice the standard dose.

LoEIII [30]

OR

  • Copper IUCD, e.g.:

LoEI [31]

  • Cu T 380A, within 5 days of unprotected intercourse.

An anti-emetic: (Z29.8)

  • Metoclopramide oral, 10 mg 8 hourly as needed.

LoEIII

STI prophylaxis (Z29.8)

  • Ceftriaxone, IM, 250 mg as a single dose.
    • For ceftriaxone IM injection: Dissolve ceftriaxone 250 mg in 0.9 mL lidocaine1% without adrenaline (epinephrine).

LoEIII [32]

AND

  • Azithromycin, oral, 1 g, as a single dose.

AND

  • Metronidazole, oral, 2 g immediately as a single dose.

HIV post-exposure prophylaxis (PEP) (Z20.6+Z29.8)

See Non-occupational post exposure prophylaxis, sexual assault and inadvertent exposure.