Z29.8
PEP should be offered to rape survivors who present within 72 hours (management is the same as for occupational HIV exposure. See : Post-exposure prophylaxis, occupational).
A patient presenting ≥72 hours since the alleged incident should not be given PEP, but should be counselled about the possible risk of transmission, with HIV testing provided at the time of presentation and 4 months later. Rape survivors who test HIV seropositive should be initiated on ART– see : Antiretroviral therapy.
Other important aspects of care for the rape survivor should not be forgotten, i.e. contraception, treatment for sexually transmitted infections, counseling and forensic specimens.
Emergency contraception after pregnancy is excluded
Do a pregnancy test in all women and female adolescents. Children must be tested and given Emergency contraception from Breast Tanner Stage III, if unsure of staging, give Emergency contraception when you detect any breast development (DO NOT REGARD MENARCHE AS AN INDICATION).
- Levonorgestrel 1.5 mg, oral, as a single dose as soon as possible after unprotected intercourse.
- Repeat the dose, if woman vomits within 2 hours.
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 levonorgestrel concentrations. Women on these medicines should double the dose of levonorgestrel, because of significant reduction of levonorgestrel. Women > 80 kg or BMI ≥ 30 should also be given twice the standard dose.
An anti-emetic:
- Metoclopramide oral, 10 mg 8 hourly as needed.
STI prophylaxis
- Ceftriaxone, IM, 250 mg as a single dose.
- For ceftriaxone IM injection: Dissolve ceftriaxone 250 mg in 0.9 mL lidocaine 1% without epinephrine (adrenaline).
AND
- Azithromycin, oral, 1 g, as a single dose.
AND
- Metronidazole, oral, 2 g immediately as a single dose.
Inadvertent (non-occupational) exposure to infectious material from HIV sero-positive persons often requires clinical judgement and includes:
- human bites (requires hepatitis B, but not HIV prophylaxis)
- sharing of needles during recreational drug use
- consensual sexual exposure, burst condoms
- contact sports with blood exposure