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Provide accurate recording of events Document injuries

Collect samples (pubic hair, fingernail scrapings, vaginal secretions, saliva, blood-stained clothing) Report to authorities as required Assure chain of evidence

C. Previous obstetric and gynecologic conditions should be sought, particularly infections, pregnancy, use of contraception, and date of the last menstrual period. Preexisting pregnancy, risk for pregnancy, and the possibility of preexisting infections should be assessed.

D. Physical examination of the entire body and photographs or drawings of the injured areas should be completed. Bruises, abrasions, and lacerations should be sought. Superficial or extensive lacerations of the hymen and vagina, injury to the urethra, and occasionally rupture of the vaginal vault into the abdominal cavity may be noted. Bite marks are common.

1. Pelvic examination should assess the status of the reproductive organs, collect samples from the cervix and vagina, and test for Neisseria gonorrhoeae and Chlamydia trachomatis.

2. A Wood light should be used to find semen on the patient's body: dried semen will fluoresce. Sperm and other Y-chromosome-bearing cells may be identified from materials collected from victims.

E. A serum sample should be obtained for baseline serology for syphilis, herpes simplex virus, hepatitis B virus, and HIV.

F. Trichomonas is the most frequently acquired STD. The risk of acquiring human immunodeficiency virus (HIV) <1% during a single act of heterosexual intercourse, but the risk depends on the population involved and the sexual acts performed. The risk of acquiring gonorrhea is 6-12%, and the risk of acquiring syphilis is 3%.

G. Hepatitis B virus is 20 times more infectious than HlV during sexual intercourse. Hepatitis B immune globulin (0.06 mL of hepatitis B immune globulin per kilogram) should be administered intramuscularly as soon as possible within 14 days of exposure. It is followed by the standard three-dose immunization series with hepatitis B vaccine (0, 1, and 6 months), beginning at the time of hepatitis B immune globulin administration.

H. Emergency contraception. If the patient is found to be at risk for pregnancy as a result of the assault, emergency contraception should be offered. The risk of pregnancy after sexual assault is 2-4% in victims not already using contraception. One dose of combination oral contraceptive tablets is given at the time the victim is seen and an additional dose is given in 12 hours. Emergency contraception can be effective up to 120 hours after unprotected coitus. Metoclopramide (Reglan), 20 mg with each dose of hormone, is prescribed for nausea. A pregnancy test should be performed at the 2-week return visit if conception is suspected.

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