Sexual Assault: Acute Care and Beyond

2015 ◽  
Author(s):  
Emily I Gorman ◽  
Judith Linden
Keyword(s):  
Sexual Assault ◽  
Web Sites ◽  
Sexual Contact ◽  
Definitive Treatment ◽  
Post Exposure Prophylaxis ◽  
Sexually Transmitted ◽  
Recommended Treatment ◽  
Evidence Collection ◽  
Key Aspects ◽  
Exposure Prophylaxis

Sexual assault, which encompasses any nonconsensual sexual contact, is, unfortunately, common. It results in considerable costs to society, including intangible costs such as loss of quality of life among victims. This review covers the approach to the patient and definitive treatment, disposition, and outcomes for adult and adolescent victims of sexual assault. Figures show female anatomy and common areas for genital injury after rape, a Centers for Disease Control and Prevention algorithm for evaluation of possible nonoccupational HIV exposures and nonoccupational post-exposure prophylaxis, a questionnaire for determining additional key aspects of the history of the assault to be completed and explored in detail by the sexual assault examiner, and the components and steps of the Massachusetts Sexual Assault Evidence Collection Kit. Tables list characteristics that define rape, key aspects of the history, recommended treatment to prevent sexually transmitted infections and pregnancy, calculated risks of acquiring HIV from an isolated sexual contact with a known HIV-positive person, and trauma-informed care. This review contains 5 highly rendered figures, 5 tables, 95 references, and a list of helpful Web sites.

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

scholarly journals Immediate PrEP after PEP: Results from an Observational Nurse-Led PEP2PrEP Study

2020 ◽  
Vol 19 ◽  
pp. 232595822093976
Author(s):  
Patrick O’Byrne ◽  
Lauren Orser ◽  
Amanda Vandyk
Keyword(s):  
Seroconversion Rate ◽  
Male Partner ◽  
Post Exposure Prophylaxis ◽  
Hiv Status ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Control And Prevention ◽  
Hiv Acquisition ◽  
Exposure Prophylaxis

Patients who use post-exposure prophylaxis (PEP) are at ongoing risk for HIV acquisition after completing PEP. While the Centers for Disease Control and Prevention recommends pre-exposure prophylaxis (PrEP) use immediately after PEP, some practitioners are hesitant to offer PEP-to-PrEP (PEP2PrEP). We began offering PEP2PrEP in the sexually transmitted infection clinic in Ottawa, Canada on August 5, 2018. During the first 16 months of PEP2PrEP, 61 patients requested PEP and 46 were initiated; 30 of these patients agreed to PEP2PrEP and 26 followed through. None of our PEP patients had confirmed HIV exposures; all fulfilled the initiation criterion of condomless anal sex with a male partner of unknown HIV-status. During the study, the number of PEP requests and initiations was statistical unchanged, yet the seroconversion rate among patients who used PEP decreased from 1.7% pre-PEP2PrEP to 0% post-PEP2PrEP. Regarding follow-up, most discontinuations occurred between the PrEP intake and 1-month follow-up visit.

scholarly journals Ethical Assessment of Post-Exposure Prophylaxis Guidelines in Sexual Assault Patients Suspected of Hepatitis B Viral Infection

2021 ◽  
Vol 7 (3) ◽  
pp. 29-37
Author(s):  
Jimmy Mond ◽  
Jeffrey Gruenglas
Keyword(s):  
Sexual Assault ◽  
Hepatitis B ◽  
The United States ◽  
Homeless Persons ◽  
Treatment Modalities ◽  
Post Exposure Prophylaxis ◽  
Ethical Assessment ◽  
Increased Risk ◽  
The Disabled ◽  
Exposure Prophylaxis

More than 400,000 sexual assaults are reported annually in the United States in females and males above the age of 12. Victims are likely to include members of vulnerable populations such as the disabled, homeless persons, and immigrants. Victims of such assaults are at heightened risk of contracting the Hepatitis B virus (HBV) from their assailant. Unfortunately, approximately two-thirds of people with chronic HBV are unaware of their own status, exposing for victims the risk viral transmission, disease-related cirrhosis, and hepatocellular carcinoma. Victims are also at increased risk for posttraumatic stress disorder (PTSD). Although immediate vaccination of the assaulted victim is recommended, protective levels of antibody are not present for fourteen days post vaccination. Complementary treatment with a Hepatitis B immune globulin (HBIG), however, may provide immediate protective serum concentrations. Prompt prophylactic therapeutic intervention may not only protect patients from risk of infection but may also prevent the effects of PTSD by providing victims with psychological and emotional benefit. Yet, existing Centers for Disease Control and Preventions (CDC) recommendations for suspected HBV infection in sexual assault patients recommend initiating immunoprophylaxis only in cases where the perpetrator’s HBsAg status is known, a guideline that perpetuates inequities and injustice for those equally subject to the harms of sexual assault. This paper presents an ethical assessment of prophylactic treatment for sexual assault patients suspected of HBV exposure. In the absence of equitable guidelines, we argue for the clinician’s duty to rescue sexually assaulted patients from future harm and to protect the public through mitigation of transmission using currently available and evidence-based treatment modalities. The paper concludes with an ethical foundation to advocate for modification of current guidelines in view of existing prophylactic regimens.

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