Screening and Treatment of Sexually Transmissible Infections Following Sexual Assault

Initial Examination

Infection

• Testing for and gonorrhea and chlamydia from specimens from any sites of penetration or attempted penetration

• Wet mount and culture or a vaginal swab specimen for Trichomonas

• Serum sample for syphilis, herpes simplex virus, hepatitis B virus, and HIV

Pregnancy Prevention Prophylaxis

• Hepatitis B virus vaccination and hepatitis B immune globulin.

• Empiric recommended antimicrobial therapy for chlamydial, gonococcal, and trichomonal infections and for bacterial vaginosis:

Ceftriaxone, 125 mg intramuscularly in a single dose, plus

Metronidazole, 2 g orally in a single dose, plus Doxycycline 100 mg orally two times a day for 7 days Azithromycin (Zithromax) is used if the patient is unlikely to comply with the 7 day course of doxycycline; single dose of four 250 mg caps. If the patient is penicillin-allergic, ciprofloxacin 500 mg PO or ofloxacin 400 mg PO is substituted for ceftriaxone. If the patient is pregnant, erythromycin 500 mg PO qid for 7 days is substituted for doxycycline. HIV prophylaxis consists of zidovudine (AZT) 200 mg PO tid, plus lamivudine (3TC) 150 mg PO bid for 4 weeks.

Follow-Up Examination (2 weeks)

• Cultures for N gonorrhoeae and C trachomatis (not needed if prophylactic treatment has been provided)

• Wet mount and culture for T vaginalis

• Collection of serum sample for subsequent serologic analysis if test results are positive

Follow-Up Examination (12 weeks)

Serologic tests for infectious agents: T pallidum

HIV (repeat test at 6 months)

Hepatitis B virus (not needed if hepatitis B virus vaccine was given)

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