Sexual Assault

Rape/Sexual Assault Protocol
Rape Kit: Can only be performed in ER. SW should be aware pt is in ER. No showering preferred. Easy to follow instructions.

SAVI: Must be notified. Patient advocates on call 24/7 for rape cases

Meds to offer patient:

• Plan B (up to 120 hours after event)
• Zithromax 1 gm po x1 (Chlamydia)
• Ciprofloxin 500 mg pox1 or Ceftriaxone 250mg IM x1 (gonorrhea)
• Flagyl 2 gm po x1 (trich)
• HIV post-exposure prophylaxis (“pep”) – Combivir (AZT and 3TC in combination pill) 1 tab po bid x4 weeks. Must start w/in 24 hours of exposure. Discuss s/e of meds (esp n/v/d) and have f/u in 3 days to check on compliance and s/e (can give anti-emetics, anti-motility agents to manage s/e)
• Hep B 0.5 cc IM if not previously immunized

Baseline Labs to offer: these will not be positive for at least 5 days from assault or up to 3 months for HIV

• RPR
• HIV
• GC/CT

Laws re mandatory reporting in New York State:

• Physicians should not report rape to police (must protect patient confidentiality unless stabbing/ shooting involved)
• Report caregivers to ACS if they were perpetrators or if they were aware of rape/abuse and did nothing to prevent it
• Physicians are not obligated to report consensual sex between teen and older partner; always document in medical record that sex is consensual and non-coercive