Sexual violence resident survival guide: Difference between revisions

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{| class="infobox" style="margin: 0 0 0 0; border: 0; float: right; width: 100px; background: #A8A8A8; position: fixed; top: 250px; right: 21px; border-radius: 0 0 10px 10px;" cellpadding="0" cellspacing="0" ;
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! style="padding: 0 5px; font-size: 85%; background: #A8A8A8" align="center" |{{fontcolor|#2B3B44|Sexual Violence Resident Survival Guide Microchapters}}
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sexual violence resident survival guide#Overview|Overview]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sexual violence resident survival guide#Causes|Causes]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sexual violence resident survival guide#Diagnosis|Diagnosis]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sexual violence resident survival guide#Treatment|Treatment]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sexual violence resident survival guide#Dos|Dos]]
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! style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align="left" |[[Sexual violence resident survival guide#Don'ts|Don'ts]]
|}


{{WikiDoc CMG}}; {{AE}} {{RAB}}
{{WikiDoc CMG}}; {{AE}} {{RAB}}


{{SK}}
{{SK}}Approach to Sexual Violence; Approach to Physical Violence; Approach to [[Sexual assault|Sexual Assault]]; Approach to [[Rape]]
==Overview==
==Overview==
Sexual violence is a public health issue  as well as violation of human rights. It has many forms,for example [[rape]], [[sexual assault]], sexual coercion, sexual harassment, sexual exploitation,sexual battery. It occurs without the consent of the victim or when the victim refuses or is unable to give a consent due to age, [[intoxication]], illnesss or any other reasons.It is a common problem that may be seen in primary care.It is important for physicians to identify if a person has suffered any type of sexual violence and take care of their safety.Though the evaluation and treatment of sexual assault victims are mostly limited to female and pediatric patients a few of the guidelines being applicable to male victims. Most of the post-examination follow-up guuidelines focus on the factors affecting female survivors. There is limited studies focusing on male and homosexual survivors and factors affecting their treatment and follow-up.  
Sexual violence is a [[public health]] concern as well as violation of human rights. It has many forms which include [[rape]], [[sexual assault]], [[Sexual activities|sexual]] coercion, [[Sexual activities|sexual]] [[harassment]], [[Sexual act|sexual]] exploitation, and [[Sexual act|sexual]] battery. It occurs without the consent of the victim or when the victim refuses or is unable to give a consent due to age, [[intoxication]], [[illness]] or any other reasons. It is a common problem that may be seen in [[primary care]]. It is important for physicians to identify if a person has suffered from any type of [[sexual violence]] and take care of their safety. The evaluation and treatment of [[sexual assault]] victims are mostly limited to female and pediatric patients but a few of the guidelines are applicable to male victims as well. Though most of the post-[[Physical examination|examination]] follow-up guidelines focus on the factors affecting female victims, there are a few studies that focus on male and [[homosexual]] victims and factors affecting their [[treatment]] and follow-up.


==Causes==
==Causes==
===Common Causes===
===Common Causes<ref name="pmid23275472">{{cite journal |vauthors=Tharp AT, DeGue S, Valle LA, Brookmeyer KA, Massetti GM, Matjasko JL |title=A systematic qualitative review of risk and protective factors for sexual violence perpetration |journal=Trauma Violence Abuse |volume=14 |issue=2 |pages=133–67 |date=April 2013 |pmid=23275472 |doi=10.1177/1524838012470031 |url= |issn=}}</ref><ref name="MaxwellRobinson2003">{{cite journal|last1=Maxwell|first1=Christopher D.|last2=Robinson|first2=Amanda L.|last3=Post|first3=Lori A.|title=The Nature and Predictors of Sexual Victimization and Offending Among Adolescents|journal=Journal of Youth and Adolescence|volume=32|issue=6|year=2003|pages=465–477|issn=0047-2891|doi=10.1023/A:1025942503285}}</ref><ref name="YbarraMitchell2011">{{cite journal|last1=Ybarra|first1=Michele L.|last2=Mitchell|first2=Kimberly J.|last3=Hamburger|first3=Merle|last4=Diener-West|first4=Marie|last5=Leaf|first5=Philip J.|title=X-rated material and perpetration of sexually aggressive behavior among children and adolescents: is there a link?|journal=Aggressive Behavior|volume=37|issue=1|year=2011|pages=1–18|issn=0096140X|doi=10.1002/ab.20367}}</ref>===
 
While it is hard to pinpoint medical causes for sexual violence, many risk factors have been associated with the aggressor:
*[[Common cause 1|Aggressive nature, including hostility against women]]<ref name="pmid23275472">{{cite journal |vauthors=Tharp AT, DeGue S, Valle LA, Brookmeyer KA, Massetti GM, Matjasko JL |title=A systematic qualitative review of risk and protective factors for sexual violence perpetration |journal=Trauma Violence Abuse |volume=14 |issue=2 |pages=133–67 |date=April 2013 |pmid=23275472 |doi=10.1177/1524838012470031 |url= |issn=}}</ref>
*[[Common cause 1|Aggressive nature, including hostility against women]]<ref name="pmid23275472">{{cite journal |vauthors=Tharp AT, DeGue S, Valle LA, Brookmeyer KA, Massetti GM, Matjasko JL |title=A systematic qualitative review of risk and protective factors for sexual violence perpetration |journal=Trauma Violence Abuse |volume=14 |issue=2 |pages=133–67 |date=April 2013 |pmid=23275472 |doi=10.1177/1524838012470031 |url= |issn=}}</ref>
*[[Common cause 2|Rape-supportive attitudes]]<ref name="MaxwellRobinson2003">{{cite journal|last1=Maxwell|first1=Christopher D.|last2=Robinson|first2=Amanda L.|last3=Post|first3=Lori A.|title=The Nature and Predictors of Sexual Victimization and Offending Among Adolescents|journal=Journal of Youth and Adolescence|volume=32|issue=6|year=2003|pages=465–477|issn=0047-2891|doi=10.1023/A:1025942503285}}</ref>
*[[Common cause 2|Rape-supportive attitudes]]<ref name="MaxwellRobinson2003">{{cite journal|last1=Maxwell|first1=Christopher D.|last2=Robinson|first2=Amanda L.|last3=Post|first3=Lori A.|title=The Nature and Predictors of Sexual Victimization and Offending Among Adolescents|journal=Journal of Youth and Adolescence|volume=32|issue=6|year=2003|pages=465–477|issn=0047-2891|doi=10.1023/A:1025942503285}}</ref>
*[[Common cause 3|Alcohol use]]
*[[Alcohol]] use
*[[Common cause 4|Nonsexual delinquency]]
*[[Common cause 4|Nonsexual delinquency]]
*[[Common cause 5|Lack of parental monitoring]]
*[[Common cause 5|Lack of parental monitoring]]
*Poor emotional bond between caregiver and child is also associated with sexually aggressive behavior<ref name="YbarraMitchell2011">{{cite journal|last1=Ybarra|first1=Michele L.|last2=Mitchell|first2=Kimberly J.|last3=Hamburger|first3=Merle|last4=Diener-West|first4=Marie|last5=Leaf|first5=Philip J.|title=X-rated material and perpetration of sexually aggressive behavior among children and adolescents: is there a link?|journal=Aggressive Behavior|volume=37|issue=1|year=2011|pages=1–18|issn=0096140X|doi=10.1002/ab.20367}}</ref>
*Poor emotional bond between caregiver and child is also associated with [[Sexual activities|sexually]] aggressive behavior<ref name="YbarraMitchell2011">{{cite journal|last1=Ybarra|first1=Michele L.|last2=Mitchell|first2=Kimberly J.|last3=Hamburger|first3=Merle|last4=Diener-West|first4=Marie|last5=Leaf|first5=Philip J.|title=X-rated material and perpetration of sexually aggressive behavior among children and adolescents: is there a link?|journal=Aggressive Behavior|volume=37|issue=1|year=2011|pages=1–18|issn=0096140X|doi=10.1002/ab.20367}}</ref>
*Peer pressure to engage in sexual activity
*Peer pressure to engage in [[Sexual activities|sexua]][[Sex (activity)|l activity]]
*Pornography use
*Pornography use
*[[Substance abuse]]
*[[Substance abuse]]
*


==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of sexual violence.<ref name="BasileSmith2020">{{cite journal|last1=Basile|first1=Kathleen C.|last2=Smith|first2=Sharon G.|last3=Chen|first3=Jieru|last4=Zwald|first4=Marissa|title=Chronic Diseases, Health Conditions, and Other Impacts Associated With Rape Victimization of U.S. Women|journal=Journal of Interpersonal Violence|year=2020|pages=088626051990033|issn=0886-2605|doi=10.1177/0886260519900335}}</ref><ref name="pmid8765248">{{cite journal |vauthors=Holmes MM, Resnick HS, Kilpatrick DG, Best CL |title=Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women |journal=Am J Obstet Gynecol |volume=175 |issue=2 |pages=320–4; discussion 324–5 |date=August 1996 |pmid=8765248 |doi=10.1016/s0002-9378(96)70141-2 |url= |issn=}}</ref><ref name="urlMedical Examination of the Rape Victim - Gynecology and Obstetrics - MSD Manual Professional Edition">{{cite web |url=https://www.msdmanuals.com/professional/gynecology-and-obstetrics/domestic-violence-and-rape/medical-examination-of-the-rape-victim#v1065117 |title=Medical Examination of the Rape Victim - Gynecology and Obstetrics - MSD Manual Professional Edition |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
Shown below is an algorithm summarizing the diagnosis of [[Sexual assault|sexual violence]].<ref name="BasileSmith2020">{{cite journal|last1=Basile|first1=Kathleen C.|last2=Smith|first2=Sharon G.|last3=Chen|first3=Jieru|last4=Zwald|first4=Marissa|title=Chronic Diseases, Health Conditions, and Other Impacts Associated With Rape Victimization of U.S. Women|journal=Journal of Interpersonal Violence|year=2020|pages=088626051990033|issn=0886-2605|doi=10.1177/0886260519900335}}</ref><ref name="pmid8765248">{{cite journal |vauthors=Holmes MM, Resnick HS, Kilpatrick DG, Best CL |title=Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women |journal=Am J Obstet Gynecol |volume=175 |issue=2 |pages=320–4; discussion 324–5 |date=August 1996 |pmid=8765248 |doi=10.1016/s0002-9378(96)70141-2 |url= |issn=}}</ref><ref name="urlMedical Examination of the Rape Victim - Gynecology and Obstetrics - MSD Manual Professional Edition">{{cite web |url=https://www.msdmanuals.com/professional/gynecology-and-obstetrics/domestic-violence-and-rape/medical-examination-of-the-rape-victim#v1065117 |title=Medical Examination of the Rape Victim - Gynecology and Obstetrics - MSD Manual Professional Edition |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>


{{Family tree/start}}
{{Family tree/start}}
{{Family tree | | | | | | | A01 | | | |A01=Patient with history of [[sexual violence]]}}
{{Family tree | | | | | | | A01 | | | |A01=Patient with history of [[Sexual assault|Sexual violence]]}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B01 | | | |B01= Take complete history}}
{{Family tree | | | | | | | B01 | | | |B01= Take complete history}}
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{{Family tree | | | | | | | B01 | | | |B01= Ask the following questions about the complaint }}
{{Family tree | | | | | | | B01 | | | |B01= Ask the following questions about the complaint }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 37em; width: 30em; padding:1em;"> '''Ask the following questions about circumstances of attack, including :'''<br>
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 37em; width: 30em; padding:1em;"> '''Ask details of the incident including :'''<br>
----
----
❑When did it happen,tell me the date, time, and location. <br><br>❑ Is the location familiar to you? <br><br>❑ Can you provide any information about assailants (number, name if known, description)<br><br>❑Did they use any weapon <br><br>❑Did you get any threats recently?<br><br>❑ Type of sexual contact (vaginal, oral, rectal)<br><br>❑ Did they use condom?<br><br>❑Was there any extragenital injuries sustained?<br><br>❑Occurrence of bleeding (patient or assailant)<br><br>❑Did they ejaculate, if yes, where did they ejaculate?</div>}}
❑ When did it happen? Tell me the date, time, and location. <br><br>❑ Is the location familiar to you? <br><br>❑ Can you provide any information about assailants (number, name if known, description)?<br><br>❑ Did they use any weapon or [[foreign object|foreign objects]]? <br><br>❑ Did you get any threats recently?<br><br>❑ What was the type of [[sexual]] contact ([[vaginal]], [[oral]], [[rectal]])<br><br>❑ Did they use a [[condom]]?<br><br>❑ Was there any [[External genitalia|extra-genital]] injuries sustained?<br><br>❑ Was there any occurrence of [[bleeding]] (patient or assailant)<br><br>❑ Did they [[ejaculate]], if yes, where did they [[ejaculate]]?</div>}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 30em; width: 30em; padding:1em;"> '''Ask the following questions about activities of the patient after the attack:'''<br>
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left;"> '''Ask the following questions about activities of the patient after the [[Sexual assault|sexual violence]]:'''<br>
----
----
❑Did you douch or take a bathe <br><br>❑Did you use a tampon or sanitary napkin <br><br>❑Did you urinate or defecate <br><br>❑Is there a history of use of toothpaste, mouthwash, enemas, or drugs<br><br></div>}}
❑ Did you douche or take a bath? <br><br>❑ Did you use a [[tampon]] or [[sanitary napkin]]? <br><br>❑ Did you [[urinate]] or [[Defecation|defecate]]? <br><br>❑ Is there any history of use of toothpaste, mouthwash, [[enemas]], or [[drugs]]?<br><br></div>}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 20em; width: 30em; padding:1em;"> '''Ask the following questions about menstrual history if female patient:'''<br>
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left;"> '''Ask the following questions about [[menstrual]] history if female patient:'''<br>
----
----
❑Last menstrual period<br><br>❑Date of previous coitus and time, if recent<br><br>❑Contraceptive history for example oral [[contraceptives]], [[intrauterine device]]</div>}}
❑ Last [[menstrual]] period<br><br>❑ Date of previous [[coitus]] and time<br><br>❑ [[Contraceptive]] history for example [[oral]] [[contraceptives]], [[intrauterine device]]</div>}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 15em; width: 30em; padding:1em;"> '''Record the [[Vital signs|vitals]]:'''<br>
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; "> '''Record [[Vital signs|vitals]]:'''<br>
----
----
❑ [[Blood pressure]]<br><br>
❑ [[Blood pressure]]<br><br>
❑ [[Temperature]]<br><br>❑ [[Respiratory rate]]<br><br>❑ [[Heart rate]] </div>}}
❑ [[Temperature]]<br><br>❑ [[Respiratory rate]]<br><br>❑ [[Heart rate]] </div>}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B01 | | | |B01= Do physical examination}}
{{Family tree | | | | | | | B01 | | | |B01= Do [[Physical examination]]}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height: 60em; width: 30em; padding:1em;"> '''Physical examination and evidence collection:'''<br>
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; "> '''[[Physical examination]] and [[evidence]] collection:'''<br>
----
----
❑ Look for general (extragenital) trauma or injury to any area<br><br>❑ Examine genitals to look for trauma to the perineum, [[hymen]], [[vulva]], [[vagina]], [[cervix]], or [[anus]]<br><br>❑Collect any foreign material for example stains, hair, dirt, twigs on the body <br><br>❑perform examination with Wood’s lamp or [[colposcopy]] when available<br><br>❑Collect any small samples of clothing, including an unstained sample, should be collected and examined<br><br>❑Collect hair samples, including loose hairs adhering to the patient or clothing, semen-encrusted [[pubic hair]], and clipped scalp and pubic hairs of the patient. Try to collect at least 10 of each for comparison.<br><br>❑ Check the condition of clothing, check if it is damaged, stained, or if there is any foreign material attached to any part of body<br><br>❑Take [[semen]] from the [[cervix]], [[vagina]], [[rectum]], mouth, and thighs<br><br>❑Take blood from the patient<br><br>❑Look for any dried samples of the assailant’s blood taken from the patient’s body and clothing<br><br>❑Collect urine, saliva, and smears of buccal mucosa<br><br>❑Collect fingernail clippings and scrapings<br><br>❑Collect other specimens, as described by the history of the patient or physical examination<br><br> </div>}}
❑ Look for general [[trauma]] or [[injury]] anywhere in the body.<br><br>❑ Examine the [[genital]] area to look for [[trauma]] to the [[perineum]], [[hymen]], [[vulva]], [[vagina]], [[cervix]], or [[anus]].<br><br>❑ Collect any [[foreign body|foreign material]] for example [[Stain|stains]], [[hair]], dirt on the body. <br><br>❑ Perform examination with [[Wood’s lamp]] or [[colposcopy]].<br><br>❑ Collect the victim's clothing for examination and check its condition, note if it is damaged, stained, or if there is any foreign material attached to any part of body.<br><br>❑ Collect [[hair]] samples, including loose hairs adhering to the patient or their clothing, [[semen]]-encrusted [[pubic hair]],clipped [[scalp]] and [[pubic hair|pubic hairs]] of the patient. Try to collect at least 10 of each for comparison.<br><br>❑ Take [[semen]] from the [[cervix]], [[vagina]], [[rectum]], [[mouth]], and [[thighs]].<br><br>❑ Take [[blood]] from the patient.<br><br>❑ Look for any dried samples of the assailant’s blood taken from the patient’s body and clothing.<br><br>❑ Collect [[urine]], [[saliva]], and smears of [[buccal mucosa]].<br><br>❑ Collect [[fingernail]] clippings and scrapings.<br><br> </div>}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B01 | | | |B01= Do the following investigations}}
{{Family tree | | | | | | | B01 | | | |B01= Do the following investigations}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height:52; width: 30em; padding:1em;"> '''Laboratory tests:'''<br>
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; > '''[[Laboratory|Laboratory tests]]:'''<br>
----
----
Do Acid phosphatase to detect the presence of sperm. This test is very helpful if the assailant had a [[vasectomy]], is [[oligospermia]], or used a condom, which may cause sperm to be absent. If the test cannot be done immediately, a specimen should be placed in a freezer<br><br>❑Saline suspension from the [[vagina]] to look for [[sperm]] motility. This is helpful if t can be done immediately on time to spot the motile sperm<br><br>❑[[Semen analysis]] for sperm morphology and presence of A, B, or RH grouping substances<br><br>❑Tests for [[STDs]].<br><br>❑Blood typing <br><br>❑Urine testing, including drug screen for example  drug screening for [[flunitrazepam]] (the date rape drug) and gamma-hydroxybutyrate should be considered and pregnancy tests<br><br></div>}}
[[Acid phosphatase]] test :<br>
To detect the presence of [[sperm]]. It is very helpful if the assailant had a [[vasectomy]], has [[oligospermia]], or used a [[condom]], which may cause [[sperm]] to be absent. If the test cannot be done immediately, we should preserve the specimen in a freezer.<br><br>
❑ [[Saline]] suspension from the [[vagina]]:<br>
To look for [[sperm]] motility. It is helpful if can be done immediately to spot the motile [[sperm]]<br><br>
❑ [[Semen analysis]]: <br>
For [[sperm]] morphology and presence of A, B, or RH grouping substances<br><br>
❑ Tests for [[STDs]].<br><br>❑ [[Blood]] typing <br><br>❑ [[Urine]] testing, including [[Drug|drug screen]] for example  [[Drug|drug screening]] for [[Flunitrazepam]] (the date [[rape]] [[drug]]) and [[gamma-hydroxybutyrate]]. Additionally, pregnancy tests should be done.<br><br></div>}}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | |!| | | | | }}
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; height:52; width: 30em; padding:1em;"> '''Order the follow-up tests:'''<br>
{{Family tree | | | | | | | B02 | | | |B02=<div style="float: left; text-align: left; "> '''Order the follow-up tests:'''<br>
----
----
❑Tests for [[STDS]] at 6 weeks: [[Gonorrhea]], [[chlamydial infection]], [[human papillomavirus]] infection (initially using a cervical sample from a [[Papanicolaou test]]), syphilis, and [[hepatitis]]<br><br>❑At 12 weeks: [[HIV]] infection<br><br>❑At 6 months: [[Syphilis]], [[hepatitis]], and [[HIV]] infection</div>}}
❑ Tests for [[STDs]] at 6 weeks: [[Gonorrhea]], [[Chlamydial infection]], [[HPV|Human Papilloma virus]] [[infection]] (initially using a [[cervical]] sample from a [[Papanicolaou]] test), [[Syphilis]], and [[Hepatitis]]<br><br>❑ At 12 weeks: [[HIV]] infection<br><br>❑ At 6 months: [[Syphilis]], [[Hepatitis]], and [[HIV]] [[infection]]</div>}}
{{familytree/end}}
{{familytree/end}}


==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of  
Shown below is an algorithm summarizing the treatment of [[Sexual assault|sexual violence]].<ref name="urlwww.who.int">{{cite web |url=https://www.who.int/violence_injury_prevention/resources/publications/en/guidelines_chap6.pdf |title=www.who.int |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><ref name="pmid19442425">{{cite journal |vauthors=Vickerman KA, Margolin G |title=Rape treatment outcome research: empirical findings and state of the literature |journal=Clin Psychol Rev |volume=29 |issue=5 |pages=431–48 |date=July 2009 |pmid=19442425 |pmc=2773678 |doi=10.1016/j.cpr.2009.04.004 |url= |issn=}}</ref>
 


{{familytree/start |summary=Sample 6}}
{{familytree/start |summary=Sample 6}}
{{familytree | | | | | | | | A01 |A01=Patient comes with history of sexual violence}}  
{{familytree | | | | | | | | A01 |A01=Patient comes with history of [[Sexual assault|sexual violence]]}}  
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=Non-pharmacological treatment and psychologic support|B02=Pharmacological treatment}}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=Non-pharmacological [[treatment]] and [[psychologic]] support|B02=[[Pharmacological]] treatment}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | |!| | | | | | | | | |!| |C01=C01}}
{{familytree | | | |!| | | | | | | | | |!| |C01=C01}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | |boxstyle=text-align: left; |  D01 | | | | | | | D03 |D01=•[[Stress Inoculation Training]] [[(SIT)]]
{{familytree | | | |boxstyle=text-align: left; |  D01 | | | | | | | D03 |D01=•[[Stress]] Inoculation Training [[(SIT)]]
<br>• [[Prolonged Exposure Therapy (PE)]] <br>• [[Cognitive Processing Therapy]] [[(CPT)]]<br>• [[Cognitive therapy]]<br>• Eye Movement Desensitization Reprocessing (EMDR)<br>• [[Supportive Counseling]] <br>
<br>• [[Prolonged Exposure Therapy]](PE) <br>• [[Cognitive Processing Therapy]](CPT)<br>• [[Cognitive therapy]]<br>• [[Eye Movement Desensitization and Reprocessing]] (EMDR)<br>• [[Supportive Counselling]] <br>
|D03=• Medications  for [[PTSD]] <br>•Medications for prevention of infections<br>• [[Contraceptives]] for unwanted pregnancy<br>}}
|D03=• [[Medications]] for [[PTSD]] <br>• [[Medications]] for prevention of [[infections]]<br>• [[Contraceptives]] for unwanted [[pregnancy]]<br>}}
{{familytree | | | |`|-|-|-|-|v|-|-|-|-|'|}}
{{familytree | | | |`|-|-|-|-|v|-|-|-|-|'|}}
{{familytree | | | | | | | | A02 | | | | | |A02=<div style="float: left; text-align: left; height: 60em; width: 40em; padding:1em;"> '''Further care:'''<br>
{{familytree | | | | | | | | A02 | | | | | |A02=<div style="float: left; text-align: left; "> '''Further care:'''<br>
----
----
Give the patient the opportunity to raise their questions and concerns<br><br> ❑ Reassure the patient that she did not deserve to be sexually assaulted and that the assault was not her fault <br><br> ❑Teach patients how to properly care for any injuries they have sustained <br><br> ❑ Explain how injuries heal and describe the signs and symptoms of wound infection <br><br> ❑Teach proper hygiene techniques and explain the importance of good hygiene.<br><br> ❑Discuss the signs and symptoms of [[STIs]], including [[HIV]], and the need to return for treatment if any signs and symptoms should occur.<br><br> ❑ Stress the need to use a condom during sexual intercourse until [[STI]]/[[HIV]] status has
Let the patient raise their questions and concerns.<br><br> ❑ Reassure the patient that she/he did not deserve to be [[sexually]] [[Sexual assault|assaulted]] and that the [[Sexual assault|assault]] was not their fault. <br><br> ❑ Teach patients how to properly take care of any [[injuries]] they have sustained.<br><br> ❑ Explain how [[injuries]] [[Healing|heal]] and describe the signs and symptoms of [[wound]] [[infection]].<br><br> ❑ Teach proper [[hygiene]] techniques and explain its importance.<br><br> ❑ Discuss the signs and symptoms of [[STI]], including [[HIV]], and the need to return for [[treatment]] if any signs and symptoms should occur.<br><br> ❑ Discuss the need to use a [[condom]] during [[sexual intercourse]] until [[STI]]/[[HIV]] status has been determined.<br><br> ❑ Explain the importance of completing the course of any [[medications]] given.<br><br> ❑ Discuss the side effects of any [[medications]] given.<br><br> ❑ Explain the need to refrain from [[intercourse|sexual intercourse]] until all [[treatments]] or [[prophylaxis]] for [[STI]] have been completed and until their [[sexual]] partner has been treated for [[STI]], if necessary.<br><br> ❑ Explain [[rape trauma syndrome]] and the physical, psychological and behavioral responses that the patient can expect to experience to both the patient and family members and/or significant others (if patient gives permission to share). Encourage the patient to open up and take emotional support from a trusted friend or family member.<br><br> ❑ Inform the patient of his/her legal rights and how to exercise those right.<br><br> </div>}}
been determined.<br><br> ❑ Explain the importance of completing the course of any medications given.<br><br> ❑ Discuss the side effects of any medications given.<br><br> ❑Explain the need to refrain from sexual intercourse until all treatments or prophylaxis for [[STIs]] have been completed and until her sexual partner has been treated for [[STIs]], if necessary.<br><br> ❑Explain rape trauma syndrome and the range of normal physical, psychological and behavioral responses that the patient can expect to experience to both the patient and (with the patient’s permission) family members and/or significant others. Encourage the patient to confide in and seek emotional support from a trusted friend or family member.<br><br> ❑Inform patients of their legal rights and how to exercise those right<br><br> </div>}}
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{{familytree | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | A01 | | | | |A01=Assess safety of the patient}}
{{familytree | | | | | | | | A01 | | | | |A01=Assess safety of the patient}}
{{familytree | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | B01 | | | | | B01=<div style="float: left; text-align: left; height: 30em; width: 40em; padding:1em;"> '''Ask about safety:'''<br>
{{familytree | | | | | | | | B01 | | | | | B01=<div style="float: left; text-align: left; "> '''Ask about safety:'''<br>
----
----
❑ Ask if it is not safe for the patient to return home<br><br>❑ Make appropriate referrals for shelter or safe housing, or work with her to identify a safe place that she can go to <br> <br> ❑ Discuss strategies that may help prevent another assault  <br><br> ❑ If it is a case of domestic violence, ask if there is a gun at home <br> <br> ❑ Ask if they are afraid of their partner <br><br>❑Screen for depression <br><br>❑Reassure and tell the patient that she can telephone or come into the health care facility at any time if she has any further questions, complications related to the assault, or other medical problems.</div>}}
❑ Ask if it is safe for the patient to return home.<br><br>❑ Make appropriate referrals for safe housing, or work with them to identify a safe place that they can go to.<br> <br> ❑ Discuss strategies that may help prevent another [[Sexual assault|assault]]. <br><br> ❑ If it is a case of [[Sexual assault|domestic violence]], ask if there is a gun at home.<br> <br> ❑ Ask if they are afraid of their partner.<br><br>❑ Screen for [[depression]].<br><br>❑ Reassure and tell the patient that they can call or come to the health care facility at any time if they have any further questions, complications related to the [[Sexual assault|assault]], or other medical problems.</div>}}
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{{familytree | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | A01 | | | | |A01=Follow up visits}}
{{familytree | | | | | | | | A01 | | | | |A01=Follow up visits}}
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{{familytree | | | | | | | | B01 | | | | | B01=<div style="float: left; text-align: left; height: 70em; width: 40em; padding:1em;"> '''Follow up visit at 2 week:'''<br>
{{familytree | | | | | | | | B01 | | | | | B01=<div style="float: left; text-align: left; "> '''Follow up visit at 2 week:'''<br>
----
----
❑ Examine any injuries for proper [[healing]] and take pictures of the injuries if indicated to document healing, comparisons in court<br><br>❑Check that the patient has completed the course of any medications given for STIs<br> <br> ❑ Obtain cultures and draw blood to assess [[STI]] status, especially if prophylactic antibiotics were not given at the initial visit<br> <br> ❑ Discuss results of any tests performed <br><br>❑Make follow-up appointments <br><br>❑Assess the patient’s emotional state and mental status, and encourage the
❑ Examine the [[injuries]] for proper [[healing]] and take pictures of the [[injuries]] if needed to document the healing process and for comparisons in court.<br><br>❑ Check whether the patient has completed the course of any medications given for [[STIs]].<br> <br> ❑ Obtain [[Culture collection|cultures]] and draw [[blood]] to assess [[STI]] status, especially if prophylactic [[antibiotic]] were not given at the initial visit.<br> <br> ❑ Discuss results of any tests performed.<br><br>❑ Make follow-up appointments. <br><br>❑ Assess the patient’s emotional state and mental status, and encourage the patient to seek counselling if they have not yet done so.<br><br> '''Follow up at 3 months:'''
patient to seek counseling if they have not yet done so<br><br> '''Follow up at 3 months:'''
----
----
❑Test for [[HIV]]. Make sure that pre and post-testing counseling is available or make the appropriate referral<br> <br> ❑Draw blood for [[syphilis]] testing if prophylactic antibiotics were not given previously.<br> <br> ❑Discuss any results available<br> <br> ❑Assess patient’s emotional state and mental status and encourage the patient
❑ Test for [[HIV]]. Make sure that pre and post-testing counseling is available or make the appropriate referral.<br> <br> ❑ Draw [[blood]] for [[syphilis]] testing if [[prophylactic]] [[antibiotics]] were not given previously.<br> <br> ❑ Discuss any results available<br> <br> ❑ Assess patient’s emotional state and mental status and encourage the patient to seek counselling if they have not yet done so.<br> <br> '''Follow up visit at 6 months:'''
to seek counselling if they have not yet done so.<br> <br> '''Follow up visit at 6 months:'''
----
----
❑Test for HIV. Make sure that pre and post-testing counseling is available or make an appropriate referral.<br> <br> ❑ Discuss results.<br> <br> ❑ Administer the third dose of the [[hepatitis B]] vaccine.<br> <br> ❑ Assess the patient’s emotional health and refer as necessary.
❑ Test for [[HIV]]. Make sure that pre and post-testing counseling is available or make an appropriate referral.<br> <br> ❑ Discuss results.<br> <br> ❑ Administer the third dose of the [[hepatitis B]] vaccine.<br> <br> ❑ Assess the patient’s emotional health and refer as necessary.
</div>}}
</div>}}
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{{familytree | | | | | | | | B01 | | | | | B01=<div style="float: left; text-align: left;"> '''Referrals:'''<br>
----
❑ Patients should be given both verbal and written referrals for support services such as<br>
•[[Rape]] crisis centers<br>
•Shelters or safe houses<br>
•[[HIV]]/[[AIDS]] counseling<br>
•Legal aid<br>
•Victim-witness programs<br>
•Support groups<br>
•[[Therapist|Therapists]]<br>
•Financial assistance agencies<br>
•Social service agencies</div>}}
{{familytree/end}}
{{familytree/end}}




'''Non-pharmacological treatment of [[sexual violence]]:'''
<nowiki>*</nowiki>[[Clinical depression|Click here]] to read more about screening of [[Clinical depression|depression.]]


Treatments for sexual assault victims include treatment of [[PTSD]], fear, and [[anxiety]], and/or [[depression]]
'''Non-pharmacological [[treatment]] of [[Sexual assault|Sexual violence]]:'''
 
Treatments for [[sexual assault]] victims include treatment of [[PTSD]], fear, and [[anxiety]], and/or [[depression]]


{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=[[Stress Inoculation Training]] [[ (SIT)]]
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=[[Stress Inoculation Training]] [[ (SIT)]]
|A02=<div style="float: left; text-align: left; height: 27em; width: 40em; padding:1em;"> '''Includes:'''<br>
|A02=<div style="float: left; text-align: left;"> '''Includes:'''<br>
----
----
❑ It is used to treat the victim with elevated fear and anxiety and specific avoidance behaviors.<br> <br> ❑ Psychoeducation to explain and normalize fear and avoidance behaviors <br> <br> ❑Exposure assignments to target rape-related phobias such as strange men, darkness.<br> <br> ❑ Training in behavioral and cognitive-behavioral coping strategies, specifically thought stopping, guided self-dialogue, muscle relaxation, controlled breathing, covert modeling, and role playing</div>}}
❑ It is used to treat the victim with elevated [[fear]] and [[anxiety]] and specific avoidance behaviors.<br> <br> ❑ [[Psychoeducation]] to explain and normalize [[fear]] and avoidance behaviors. <br> <br> ❑ Exposure assignments to target [[rape]]-related [[phobias]] such as strange men, darkness.<br> <br> ❑ Training in behavioral and [[cognitive]]-behavioral coping strategies, specifically thought stopping, guided self-dialogue, [[muscle]] [[relaxation]], controlled [[breathing]], covert modeling, and role playing.</div>}}
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{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01= [[Prolonged Exposure Therapy ]] |B02=<div style="float: left; text-align: left; height: 27em; width: 40em; padding:1em;"> '''Includes:'''<br>
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01= [[Prolonged Exposure Therapy ]] |B02=<div style="float: left; text-align: left; "> '''Includes:'''<br>
----
----
❑ It aims to decrease anxiety associated with rape memories, thus allowing victims to reevaluate meanings associated with the memories and construct a more organized trauma story.<br> <br>❑ Psychoeducation<br> <br> ❑Breathing training<br> <br> ❑Development of a fear and avoidance hierarchy for in vivo exposures<br> <br> ❑ Imaginal reexposure to the assault by asking the victims to relive the rape scene and describe it aloud as they are imagining it, using present tense and vivid detail. This may be done several times during one session. The victim's retelling of their rape is audio-recorded and daily homework of listening to the account is assigned for further exposure</div>}}
❑ It aims to decrease [[anxiety]] associated with [[rape]] memories, thus allowing victims to re-evaluate meanings associated with the memories and construct a more organized [[trauma]] story.<br> <br>❑ [[Psychoeducation]].<br> <br> ❑ [[Breathing]] training.<br> <br> ❑ Development of a [[fear]] and avoidance hierarchy for in vivo exposures.<br> <br> ❑ Imaginal re-exposure to the [[Sexual assault|assault]] by asking the victims to relive the [[rape]] scene and describe it aloud as they are imagining it, using present tense and vivid detail. This may be done several times during one session. The victim's retelling of their [[rape]] is audio-recorded and daily homework of listening to the account is assigned for further exposure.</div>}}
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{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01= [[Cognitive Processing Therapy]] [[(CPT)]] |B02= <div style="float: left; text-align: left; height: 35em; width: 40em; padding:1em;"> '''Includes:'''<br>
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01= [[Cognitive Processing Therapy]] [[(CPT)]] |B02= <div style="float: left; text-align: left;"> '''Includes:'''<br>
----
----
❑Helps people with PTSD.<br> <br>❑ Exposure occurs through writing assignments in which the victim describes her rape and its meaning and rereads her trauma and writes about the impact of the trauma multiple times to incorporate new understandings and reevaluations.<br> <br>❑ Other part of the therapy focuses on victims' beliefs about the meaning and implications of their trauma. <br> <br>❑Through cognitive restructuring worksheets,questioning, and discussion, one theme—safety, trust, power/control, esteem, or intimacy—is addressed in the final five sessions<br> </div>}}
❑ Helps people with [[PTSD]].<br> <br>❑ Exposure occurs through writing assignments in which the victim describes their [[rape]] and its meaning and recites their [[trauma]] and writes about the impact of the [[trauma]] multiple times to incorporate new understandings and re-evaluations.<br> <br>❑ Another part of the therapy focuses on the victim's beliefs about the meaning and implications of their [[trauma]]. <br> <br>❑ Through [[cognitive]] restructuring worksheets, questioning and discussion one theme—safety, trust, control, esteem, or intimacy are gained in the final sessions.<br> </div>}}
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{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | | |C01=Non-pharmacological treatment |C02=Eye Movement Desensitization Reprocessing  |C03= <div style="float: left; text-align: left; height: 30em; width: 40em; padding:1em;"> '''Includes:'''<br>
{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | | |C01=Non-pharmacological treatment |C02=[[Eye Movement Desensitization and Reprocessing|Eye Movement Desensitization Reprocessing]] |C03= <div style="float: left; text-align: left; "> '''Includes:'''<br>
----
----
❑helpful in treating PTSD.<br> <br>❑ A scene is used to represent the entire rape trauma and the patent imagines the scene and recites words related to the scene, while the therapist is moving her/his finger back and forth in front of her.The finger movement is hypothesized to facilitate the processing of the trauma memory through the dual attention required to attend to the therapist's finger (an external stimulus) and the trauma scene (an internal stimulus). After the client's anxiety related to the scene exposure has decreased, patient rehearses a new, adaptive belief until the new belief “feels true” <br> <br>  </div>}}
❑ Helpful in treating [[PTSD]].<br> <br>❑ A scene is used to create the entire [[rape]] [[trauma]] and the patent imagines the scene and recites words related to the scene, while the therapist moves her/his finger back and forth in front of her/him. The finger movement is hypothesized to facilitate the processing of the [[trauma]] memory through the dual attention required to attend to the therapist's finger (an external [[stimulus]]) and the [[trauma]] scene (an internal [[stimulus]]). After the patient's [[anxiety]] related to the scene exposure has decreased, patient rehearses a new, adaptive belief until the new belief feels real and true. <br> <br>  </div>}}
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{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=[[Cognitive therapy]] |D02= <div style="float: left; text-align: left; height: 15em; width: 17em; padding:1em;"> '''Includes:'''<br>
{{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=[[Cognitive therapy]] |D02= <div style="float: left; text-align: left; "> '''Includes:'''<br>
----
----
❑Here patient's fear and anxiety is acknowledged and substituted with positive thoughts</div>}}
❑ Patient's [[fear]] and [[anxiety]] is acknowledged and substituted with positive thoughts.</div>}}
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{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |`|-| E01 |-| E02 | | | |E01=[[Supportive Counseling]]|E02= <div style="float: left; text-align: left; height: 15em; width: 17em; padding:1em;"> '''Includes:'''<br>
{{familytree | | | | | | | | | |`|-| E01 |-| E02 | | | |E01=[[Supportive Counseling]]|E02= <div style="float: left; text-align: left;"> '''Includes:'''<br>
----
----
❑It shows significant pre-post improvement in PTSD, anxiety, and fear and in depression.<br> </div>}}
❑ It shows significant pre-post improvement in [[PTSD]], [[anxiety]], and [[fear]], and [[depression]].<br><br>❑ Explain that counseling and social support will help to facilitate recovery.<br>
•Listen carefully to the history of the event, ask about his/her concerns, and address them appropriately.<br>
•Explain to him/her that he/she did not deserve to be [[sexual|sexually]] violated.<br>
•Reinforce that the [[Sexual assault|assault]] was not his/her fault.<br>
•Stress that [[sexual assault|sexual violence]] is an issue of power and control<br><br>❑ It helps to decrease the isolation that victims often feel.<br>
•It provides a supportive atmosphere.<br>
•Victims are encouraged to share their experiences.<br>
•It helps victims to establish their own support network.</div>}}


{{familytree/end}}
{{familytree/end}}
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'''Pharmacological treatmnent:'''
'''[[Pharmacological]] [[treatment]]:'''


Empiric prophylaxis for [[Sexually transmitted disease|STDs]] consists of<ref name="urlSexual Assault Infectious Disease Prophylaxis - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK482239/ |title=Sexual Assault Infectious Disease Prophylaxis - StatPearls - NCBI Bookshelf |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><ref name="urlwww.who.int">{{cite web |url=https://www.who.int/violence_injury_prevention/resources/publications/en/guidelines_chap6.pdf |title=www.who.int |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
Empiric [[prophylaxis]] for [[Sexually transmitted disease|STDs]] consists of<ref name="urlSexual Assault Infectious Disease Prophylaxis - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK482239/ |title=Sexual Assault Infectious Disease Prophylaxis - StatPearls - NCBI Bookshelf |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><ref name="urlwww.who.int">{{cite web |url=https://www.who.int/violence_injury_prevention/resources/publications/en/guidelines_chap6.pdf |title=www.who.int |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
{| class="wikitable"
{| class="wikitable"
! colspan="3" rowspan="1" |First line pharmacotherapy<ref name="pmid20814491">{{cite journal |vauthors=Saddichha S |title=Diagnosis and treatment of chronic insomnia |journal=Ann Indian Acad Neurol |volume=13 |issue=2 |pages=94–102 |date=April 2010 |pmid=20814491 |pmc=2924526 |doi=10.4103/0972-2327.64628 |url= |issn=}}</ref>
! colspan="3" rowspan="1" |First line pharmacotherapy<ref name="pmid20814491">{{cite journal |vauthors=Saddichha S |title=Diagnosis and treatment of chronic insomnia |journal=Ann Indian Acad Neurol |volume=13 |issue=2 |pages=94–102 |date=April 2010 |pmid=20814491 |pmc=2924526 |doi=10.4103/0972-2327.64628 |url= |issn=}}</ref>
Line 152: Line 191:
|-
|-
| colspan="1" rowspan="1" |[[Ceftriaxone]]  Or
| colspan="1" rowspan="1" |[[Ceftriaxone]]  Or
| colspan="1" rowspan="1" |125 mg IM in a single dose
| colspan="1" rowspan="1" |125 mg IM in a single [[dose]]
| colspan="1" rowspan="3" |Gonorrhea
| colspan="1" rowspan="3" |[[Gonorrhea]]
|-
|-
|[[Ciprofloxacin]]  Or
|[[Ciprofloxacin]]  Or
|500 mg orally in a single dose
|500 mg orally in a single [[dose]]
|-
|-
|[[Cefixime]]
|[[Cefixime]]
|400 mg orally in a single dose
|400 mg orally in a single [[dose]]
|-
|-
| colspan="1" rowspan="1" |[[Metronidazole]]
| colspan="1" rowspan="1" |[[Metronidazole]]
| colspan="1" rowspan="1" |2 g orally in a single dose
| colspan="1" rowspan="1" |2 g orally in a single [[dose]]
| colspan="1" rowspan="1" |[[Trichomoniasis]] and [[bacterial vaginosis]]
| colspan="1" rowspan="1" |[[Trichomoniasis]] and [[bacterial vaginosis]]
|-
|-
| colspan="1" rowspan="1" |[[Doxycycline]]
| colspan="1" rowspan="1" |[[Doxycycline]]
| colspan="1" rowspan="1" |100 mg orally 2 times a day for 7 days<br />
| colspan="1" rowspan="1" |100 mg orally 2 times a day for 7 days<br />
| colspan="1" rowspan="2" |Chlamydial infection
| colspan="1" rowspan="2" |[[Chlamydia infection|Chlamydial infection]]
|-
|-
| colspan="1" rowspan="1" |[[Azithromycin|Azithromyci]]<nowiki/>n
| colspan="1" rowspan="1" |[[Azithromycin|Azithromyci]]<nowiki/>n
Line 173: Line 212:
|-
|-
| colspan="1" rowspan="1" |[[Azithromycin]]+[[Metronidazole]]
| colspan="1" rowspan="1" |[[Azithromycin]]+[[Metronidazole]]
| colspan="1" rowspan="1" |2g both as a single dose
| colspan="1" rowspan="1" |2g both as a single [[dose]]
| colspan="1" rowspan="1" |covers [[Gonorrhea]] and [[Chlamydial infection]]
| colspan="1" rowspan="1" |[[Gonorrhea]] and [[Chlamydial infection]]
|-
|-
|[[Benzathine penicillin G]] Or
|[[Benzathine penicillin G]] Or
|2.4 million IU IM in a single dose
|2.4 million IU IM in a single [[dose]]
| rowspan="3" |[[Syphilis]]
| rowspan="3" |[[Syphilis]]
|-
|-
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|-
|-
| colspan="1" rowspan="1" |[[Hepatitis B|Hepatitis B vaccination]]
| colspan="1" rowspan="1" |[[Hepatitis B|Hepatitis B vaccination]]
| colspan="1" rowspan="1" |0 and then 1 and 6 months after the first dose
| colspan="1" rowspan="1" |0 and then 1 and 6 months after the first [[dose]]
| colspan="1" rowspan="1" |To prevent [[Hepatitis B]] if the patient is not vaccinated before
| colspan="1" rowspan="1" |To prevent [[Hepatitis B]] if the patient is not [[vaccinated]] before
|-
|-
| colspan="1" rowspan="1" |Combination of [[zidovudine]] (ZDV) 300 mg and [[lamivudine]] (3TC)<ref name="pmid16117282">{{cite journal |vauthors=Meel BL |title=HIV/AIDS post-exposure prophylaxis (PEP) for victims of sexual assault in South Africa |journal=Med Sci Law |volume=45 |issue=3 |pages=219–24 |date=July 2005 |pmid=16117282 |doi=10.1258/rsmmsl.45.3.219 |url= |issn=}}</ref><ref name="pmid31603619">{{cite journal |vauthors=Inciarte A, Leal L, Masfarre L, Gonzalez E, Diaz-Brito V, Lucero C, Garcia-Pindado J, León A, García F |title=Post-exposure prophylaxis for HIV infection in sexual assault victims |journal=HIV Med |volume=21 |issue=1 |pages=43–52 |date=January 2020 |pmid=31603619 |pmc=6916272 |doi=10.1111/hiv.12797 |url= |issn=}}</ref>
| colspan="1" rowspan="1" |Combination of [[zidovudine]] (ZDV) 300 mg and [[lamivudine]] (3TC)<ref name="pmid16117282">{{cite journal |vauthors=Meel BL |title=HIV/AIDS post-exposure prophylaxis (PEP) for victims of sexual assault in South Africa |journal=Med Sci Law |volume=45 |issue=3 |pages=219–24 |date=July 2005 |pmid=16117282 |doi=10.1258/rsmmsl.45.3.219 |url= |issn=}}</ref><ref name="pmid31603619">{{cite journal |vauthors=Inciarte A, Leal L, Masfarre L, Gonzalez E, Diaz-Brito V, Lucero C, Garcia-Pindado J, León A, García F |title=Post-exposure prophylaxis for HIV infection in sexual assault victims |journal=HIV Med |volume=21 |issue=1 |pages=43–52 |date=January 2020 |pmid=31603619 |pmc=6916272 |doi=10.1111/hiv.12797 |url= |issn=}}</ref>
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
*50 mg is given orally 2 times a day for 4 weeks in low-risk cases
*50 mg is given orally 2 times a day for 4 weeks in low-risk cases
*If risk is higher [[Protease inhibitor|Protease Inhibitor]] is added
*If the risk is higher [[Protease inhibitor|Protease Inhibitor]] is added
| colspan="1" rowspan="1" |Prophylaxis for [[Human Immunodeficiency Virus (HIV)|HIV]] infection is best begun < 4 hours after penetration and should not be given after > 72 hours
| colspan="1" rowspan="1" |Prophylaxis for [[Human Immunodeficiency Virus (HIV)|HIV]] [[infection]] is best if it is given < 4 hours after penetration and should not be given after > 72 hours
[[Human Immunodeficiency Virus (HIV)|HIV]] prophylaxis is required in the following circumstances:
[[Human Immunodeficiency Virus (HIV)|HIV]] [[prophylaxis]] is required in the following cases:


*Anal penetration
*Anal penetration
*Bleeding (assailant or victim)
*[[Bleeding]]
*Male-male rape
*[[Homosexual men|Homosexual rape]]
*Rape by multiple assailants (male victims in prisons)
*[[Rape]] by multiple assailants (male victims in prisons)
*Rape in areas with a high prevalence of [[Human Immunodeficiency Virus (HIV)|HIV]] infection
*[[Rape]] in areas with a high prevalence of [[Human Immunodeficiency Virus (HIV)|HIV]] [[infection]]
|-
|-
| colspan="1" rowspan="1" |Contraception
| colspan="1" rowspan="1" |[[Birth control|Contraception]]
 
*Emergency [[oral contraceptive]]
*Emergency oral contraceptive
**[[Progestin-only oral contraceptives (patient information)|Progestin-only ECPs]]
**[[Progestin-only oral contraceptives (patient information)|Progestin-only ECPs]]
**Combined estrogen-progesterone pills
**Combined estrogen-progesterone pills
Line 212: Line 250:




A single dose for progestin-only pills. To doses, 12 hours apart and within 72 hours of the assault
A single dose for progestin-only pills.  


for combined pills.  
Two doses, 12 hours apart and within 72 hours of the assault for combined pills.


| colspan="1" rowspan="1" |It is offered to all women with a negative pregnancy test.  
| colspan="1" rowspan="1" |It is offered to all women with a negative pregnancy test.  


*[[Oral contraceptive|Oral contraceptives]] are used. If used > 72 hours after a rape, they are much less likely to be effective. An [[antiemetic]] may help if nausea develops.
*[[Oral contraceptive|Oral contraceptives]] are used. If used > 72 hours after a [[rape]], they are much less likely to be effective. An [[antiemetic]] may help if [[nausea]] develops.




*An [[intrauterine device]] may be effective if used up to 10 days after the rape.
*An [[intrauterine device]] may be effective if used up to 10 days after the [[rape]].
|}<br />
|}<br />


==Do's==
==Dos==
<br />
 
*Make sure the victim is not left alone.
*Make sure the victim is not left alone.
*Provide emotional support and reassure the victim that they are not at fault for what happened.
*Provide emotional support and reassure the victim that they are not at fault for what happened.
*If the victim has been raped, a doctor will use a rape kit to collect hair, [[semen]], clothing fibers, and other evidence of the attacker's identity
*If the victim has been [[Rape|raped]], a doctor will use a [[rape]] kit to collect hair, [[semen]], clothing fibers, and other evidence of the attacker's identity.
*Even if the victim is not sure they want to report about the violence, it is important to collect and preserve evidence so it can be accessed at a later date, if required.
*Even if the victim is not sure they want to report about the [[Sexual assault|violence]], it is important to collect and preserve evidence so it can be accessed at a later date if required.


*If the victim wishes to report about the violence, the staffs of the hospital will call the police from the emergency room.
*If the victim wishes to report about the [[Sexual assault|violence]], the staff of the hospital will call the police from the emergency room.
*Victims should be treated for [[Sexually transmitted disease|sexually transmitted diseases]] ([[Sexually transmitted disease|STD]]<nowiki/>s)
*Victims should be treated for [[Sexually transmitted disease|sexually transmitted diseases]] ([[Sexually transmitted disease|STD]]<nowiki/>s)
*Victims should be told about emergency birth control. It is important to receive birth control and treatment for [[Sexually transmitted disease|STD]]<nowiki/>s within 72 hours of the assault for maximum effectiveness. Although victims can get emergency [[contraception]] up to 5 days after but it will be less effective.
*Victims should be told about emergency [[birth control]]. It is important to receive [[birth control]] and treatment for [[Sexually transmitted disease|STD]]<nowiki/>s within 72 hours of the [[Sexual assault|assault]] for maximum effectiveness. Although victims can get emergency [[contraception]] up to 5 days after, it will be less effective.
**
**


Line 241: Line 277:
==Don'ts==
==Don'ts==


*To preserve evidence, the victim should not take a bathe, go to the bathroom, comb their hair, or change clothes until they have received a medical examination.
*To preserve evidence, the victim should not take a bath, go to the bathroom, comb their hair, or change clothes until they have received a medical examination.
*Do not clean up anything at the site of the assault.
*Do not clean up anything at the site of the [[Sexual assault|assault]].


*
*
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[[Category:Resident survival guide]]
[[Category:Resident survival guide]]
[[Category:Templates]]
[[Category:Templates]]
[[category:Up-To-Date]]


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Latest revision as of 15:14, 8 February 2021

Sexual Violence Resident Survival Guide Microchapters
Overview
Causes
Diagnosis
Treatment
Dos
Don'ts

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:Approach to Sexual Violence; Approach to Physical Violence; Approach to Sexual Assault; Approach to Rape

Overview

Sexual violence is a public health concern as well as violation of human rights. It has many forms which include rape, sexual assault, sexual coercion, sexual harassment, sexual exploitation, and sexual battery. It occurs without the consent of the victim or when the victim refuses or is unable to give a consent due to age, intoxication, illness or any other reasons. It is a common problem that may be seen in primary care. It is important for physicians to identify if a person has suffered from any type of sexual violence and take care of their safety. The evaluation and treatment of sexual assault victims are mostly limited to female and pediatric patients but a few of the guidelines are applicable to male victims as well. Though most of the post-examination follow-up guidelines focus on the factors affecting female victims, there are a few studies that focus on male and homosexual victims and factors affecting their treatment and follow-up.

Causes

Common Causes[1][2][3]

While it is hard to pinpoint medical causes for sexual violence, many risk factors have been associated with the aggressor:

Diagnosis

Shown below is an algorithm summarizing the diagnosis of sexual violence.[4][5][6]

 
 
 
 
 
 
Patient with history of Sexual violence
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Take complete history
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about the complaint
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask details of the incident including :

❑ When did it happen? Tell me the date, time, and location.

❑ Is the location familiar to you?

❑ Can you provide any information about assailants (number, name if known, description)?

❑ Did they use any weapon or foreign objects?

❑ Did you get any threats recently?

❑ What was the type of sexual contact (vaginal, oral, rectal)

❑ Did they use a condom?

❑ Was there any extra-genital injuries sustained?

❑ Was there any occurrence of bleeding (patient or assailant)

❑ Did they ejaculate, if yes, where did they ejaculate?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about activities of the patient after the sexual violence:

❑ Did you douche or take a bath?

❑ Did you use a tampon or sanitary napkin?

❑ Did you urinate or defecate?

❑ Is there any history of use of toothpaste, mouthwash, enemas, or drugs?

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask the following questions about menstrual history if female patient:

❑ Last menstrual period

❑ Date of previous coitus and time

Contraceptive history for example oral contraceptives, intrauterine device
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do Physical examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical examination and evidence collection:

❑ Look for general trauma or injury anywhere in the body.

❑ Examine the genital area to look for trauma to the perineum, hymen, vulva, vagina, cervix, or anus.

❑ Collect any foreign material for example stains, hair, dirt on the body.

❑ Perform examination with Wood’s lamp or colposcopy.

❑ Collect the victim's clothing for examination and check its condition, note if it is damaged, stained, or if there is any foreign material attached to any part of body.

❑ Collect hair samples, including loose hairs adhering to the patient or their clothing, semen-encrusted pubic hair,clipped scalp and pubic hairs of the patient. Try to collect at least 10 of each for comparison.

❑ Take semen from the cervix, vagina, rectum, mouth, and thighs.

❑ Take blood from the patient.

❑ Look for any dried samples of the assailant’s blood taken from the patient’s body and clothing.

❑ Collect urine, saliva, and smears of buccal mucosa.

❑ Collect fingernail clippings and scrapings.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do the following investigations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Laboratory tests:

Acid phosphatase test :
To detect the presence of sperm. It is very helpful if the assailant had a vasectomy, has oligospermia, or used a condom, which may cause sperm to be absent. If the test cannot be done immediately, we should preserve the specimen in a freezer.

Saline suspension from the vagina:
To look for sperm motility. It is helpful if can be done immediately to spot the motile sperm

Semen analysis:
For sperm morphology and presence of A, B, or RH grouping substances

❑ Tests for STDs.

Blood typing

Urine testing, including drug screen for example drug screening for Flunitrazepam (the date rape drug) and gamma-hydroxybutyrate. Additionally, pregnancy tests should be done.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order the follow-up tests:

❑ Tests for STDs at 6 weeks: Gonorrhea, Chlamydial infection, Human Papilloma virus infection (initially using a cervical sample from a Papanicolaou test), Syphilis, and Hepatitis

❑ At 12 weeks: HIV infection

❑ At 6 months: Syphilis, Hepatitis, and HIV infection
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of sexual violence.[7][8]

 
 
 
 
 
 
 
Patient comes with history of sexual violence
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-pharmacological treatment and psychologic support
 
 
 
 
 
 
 
Pharmacological treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stress Inoculation Training (SIT)
Prolonged Exposure Therapy(PE)
Cognitive Processing Therapy(CPT)
Cognitive therapy
Eye Movement Desensitization and Reprocessing (EMDR)
Supportive Counselling
 
 
 
 
 
 
Medications for PTSD
Medications for prevention of infections
Contraceptives for unwanted pregnancy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Further care:

❑ Let the patient raise their questions and concerns.

❑ Reassure the patient that she/he did not deserve to be sexually assaulted and that the assault was not their fault.

❑ Teach patients how to properly take care of any injuries they have sustained.

❑ Explain how injuries heal and describe the signs and symptoms of wound infection.

❑ Teach proper hygiene techniques and explain its importance.

❑ Discuss the signs and symptoms of STI, including HIV, and the need to return for treatment if any signs and symptoms should occur.

❑ Discuss the need to use a condom during sexual intercourse until STI/HIV status has been determined.

❑ Explain the importance of completing the course of any medications given.

❑ Discuss the side effects of any medications given.

❑ Explain the need to refrain from sexual intercourse until all treatments or prophylaxis for STI have been completed and until their sexual partner has been treated for STI, if necessary.

❑ Explain rape trauma syndrome and the physical, psychological and behavioral responses that the patient can expect to experience to both the patient and family members and/or significant others (if patient gives permission to share). Encourage the patient to open up and take emotional support from a trusted friend or family member.

❑ Inform the patient of his/her legal rights and how to exercise those right.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess safety of the patient
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ask about safety:

❑ Ask if it is safe for the patient to return home.

❑ Make appropriate referrals for safe housing, or work with them to identify a safe place that they can go to.

❑ Discuss strategies that may help prevent another assault.

❑ If it is a case of domestic violence, ask if there is a gun at home.

❑ Ask if they are afraid of their partner.

❑ Screen for depression.

❑ Reassure and tell the patient that they can call or come to the health care facility at any time if they have any further questions, complications related to the assault, or other medical problems.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow up visits
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow up visit at 2 week:

❑ Examine the injuries for proper healing and take pictures of the injuries if needed to document the healing process and for comparisons in court.

❑ Check whether the patient has completed the course of any medications given for STIs.

❑ Obtain cultures and draw blood to assess STI status, especially if prophylactic antibiotic were not given at the initial visit.

❑ Discuss results of any tests performed.

❑ Make follow-up appointments.

❑ Assess the patient’s emotional state and mental status, and encourage the patient to seek counselling if they have not yet done so.

Follow up at 3 months:


❑ Test for HIV. Make sure that pre and post-testing counseling is available or make the appropriate referral.

❑ Draw blood for syphilis testing if prophylactic antibiotics were not given previously.

❑ Discuss any results available

❑ Assess patient’s emotional state and mental status and encourage the patient to seek counselling if they have not yet done so.

Follow up visit at 6 months:


❑ Test for HIV. Make sure that pre and post-testing counseling is available or make an appropriate referral.

❑ Discuss results.

❑ Administer the third dose of the hepatitis B vaccine.

❑ Assess the patient’s emotional health and refer as necessary.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Referrals:

❑ Patients should be given both verbal and written referrals for support services such as
Rape crisis centers
•Shelters or safe houses
HIV/AIDS counseling
•Legal aid
•Victim-witness programs
•Support groups
Therapists
•Financial assistance agencies

•Social service agencies
 
 
 
 


*Click here to read more about screening of depression.

Non-pharmacological treatment of Sexual violence:

Treatments for sexual assault victims include treatment of PTSD, fear, and anxiety, and/or depression

 
 
 
 
 
 
 
 
 
 
 
 
Stress Inoculation Training (SIT)
 
Includes:

❑ It is used to treat the victim with elevated fear and anxiety and specific avoidance behaviors.

Psychoeducation to explain and normalize fear and avoidance behaviors.

❑ Exposure assignments to target rape-related phobias such as strange men, darkness.

❑ Training in behavioral and cognitive-behavioral coping strategies, specifically thought stopping, guided self-dialogue, muscle relaxation, controlled breathing, covert modeling, and role playing.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Prolonged Exposure Therapy
 
Includes:

❑ It aims to decrease anxiety associated with rape memories, thus allowing victims to re-evaluate meanings associated with the memories and construct a more organized trauma story.

Psychoeducation.

Breathing training.

❑ Development of a fear and avoidance hierarchy for in vivo exposures.

❑ Imaginal re-exposure to the assault by asking the victims to relive the rape scene and describe it aloud as they are imagining it, using present tense and vivid detail. This may be done several times during one session. The victim's retelling of their rape is audio-recorded and daily homework of listening to the account is assigned for further exposure.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cognitive Processing Therapy (CPT)
 
Includes:

❑ Helps people with PTSD.

❑ Exposure occurs through writing assignments in which the victim describes their rape and its meaning and recites their trauma and writes about the impact of the trauma multiple times to incorporate new understandings and re-evaluations.

❑ Another part of the therapy focuses on the victim's beliefs about the meaning and implications of their trauma.

❑ Through cognitive restructuring worksheets, questioning and discussion one theme—safety, trust, control, esteem, or intimacy are gained in the final sessions.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-pharmacological treatment
 
 
 
 
Eye Movement Desensitization Reprocessing
 
Includes:

❑ Helpful in treating PTSD.

❑ A scene is used to create the entire rape trauma and the patent imagines the scene and recites words related to the scene, while the therapist moves her/his finger back and forth in front of her/him. The finger movement is hypothesized to facilitate the processing of the trauma memory through the dual attention required to attend to the therapist's finger (an external stimulus) and the trauma scene (an internal stimulus). After the patient's anxiety related to the scene exposure has decreased, patient rehearses a new, adaptive belief until the new belief feels real and true.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cognitive therapy
 
Includes:

❑ Patient's fear and anxiety is acknowledged and substituted with positive thoughts.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Supportive Counseling
 
Includes:

❑ It shows significant pre-post improvement in PTSD, anxiety, and fear, and depression.

❑ Explain that counseling and social support will help to facilitate recovery.
•Listen carefully to the history of the event, ask about his/her concerns, and address them appropriately.
•Explain to him/her that he/she did not deserve to be sexually violated.
•Reinforce that the assault was not his/her fault.
•Stress that sexual violence is an issue of power and control

❑ It helps to decrease the isolation that victims often feel.
•It provides a supportive atmosphere.
•Victims are encouraged to share their experiences.

•It helps victims to establish their own support network.
 
 
 
 
 
 


Pharmacological treatment:

Empiric prophylaxis for STDs consists of[9][7]

First line pharmacotherapy[10]
Medication Recommended dosage Disease
Ceftriaxone Or 125 mg IM in a single dose Gonorrhea
Ciprofloxacin Or 500 mg orally in a single dose
Cefixime 400 mg orally in a single dose
Metronidazole 2 g orally in a single dose Trichomoniasis and bacterial vaginosis
Doxycycline 100 mg orally 2 times a day for 7 days
Chlamydial infection
Azithromycin 1 g orally once
Azithromycin+Metronidazole 2g both as a single dose Gonorrhea and Chlamydial infection
Benzathine penicillin G Or 2.4 million IU IM in a single dose Syphilis
Doxycycline Or 100 mg orally twice a day for 14 days
Tetracycline 500 mg orally 4 times a day for 14 days
Hepatitis B vaccination 0 and then 1 and 6 months after the first dose To prevent Hepatitis B if the patient is not vaccinated before
Combination of zidovudine (ZDV) 300 mg and lamivudine (3TC)[11][12]
  • 50 mg is given orally 2 times a day for 4 weeks in low-risk cases
  • If the risk is higher Protease Inhibitor is added
Prophylaxis for HIV infection is best if it is given < 4 hours after penetration and should not be given after > 72 hours

HIV prophylaxis is required in the following cases:

Contraception


A single dose for progestin-only pills.

Two doses, 12 hours apart and within 72 hours of the assault for combined pills.

It is offered to all women with a negative pregnancy test.



Dos

  • Make sure the victim is not left alone.
  • Provide emotional support and reassure the victim that they are not at fault for what happened.
  • If the victim has been raped, a doctor will use a rape kit to collect hair, semen, clothing fibers, and other evidence of the attacker's identity.
  • Even if the victim is not sure they want to report about the violence, it is important to collect and preserve evidence so it can be accessed at a later date if required.
  • If the victim wishes to report about the violence, the staff of the hospital will call the police from the emergency room.
  • Victims should be treated for sexually transmitted diseases (STDs)
  • Victims should be told about emergency birth control. It is important to receive birth control and treatment for STDs within 72 hours of the assault for maximum effectiveness. Although victims can get emergency contraception up to 5 days after, it will be less effective.

Don'ts

  • To preserve evidence, the victim should not take a bath, go to the bathroom, comb their hair, or change clothes until they have received a medical examination.
  • Do not clean up anything at the site of the assault.

References

  1. 1.0 1.1 Tharp AT, DeGue S, Valle LA, Brookmeyer KA, Massetti GM, Matjasko JL (April 2013). "A systematic qualitative review of risk and protective factors for sexual violence perpetration". Trauma Violence Abuse. 14 (2): 133–67. doi:10.1177/1524838012470031. PMID 23275472.
  2. 2.0 2.1 Maxwell, Christopher D.; Robinson, Amanda L.; Post, Lori A. (2003). "The Nature and Predictors of Sexual Victimization and Offending Among Adolescents". Journal of Youth and Adolescence. 32 (6): 465–477. doi:10.1023/A:1025942503285. ISSN 0047-2891.
  3. 3.0 3.1 Ybarra, Michele L.; Mitchell, Kimberly J.; Hamburger, Merle; Diener-West, Marie; Leaf, Philip J. (2011). "X-rated material and perpetration of sexually aggressive behavior among children and adolescents: is there a link?". Aggressive Behavior. 37 (1): 1–18. doi:10.1002/ab.20367. ISSN 0096-140X.
  4. Basile, Kathleen C.; Smith, Sharon G.; Chen, Jieru; Zwald, Marissa (2020). "Chronic Diseases, Health Conditions, and Other Impacts Associated With Rape Victimization of U.S. Women". Journal of Interpersonal Violence: 088626051990033. doi:10.1177/0886260519900335. ISSN 0886-2605.
  5. Holmes MM, Resnick HS, Kilpatrick DG, Best CL (August 1996). "Rape-related pregnancy: estimates and descriptive characteristics from a national sample of women". Am J Obstet Gynecol. 175 (2): 320–4, discussion 324–5. doi:10.1016/s0002-9378(96)70141-2. PMID 8765248.
  6. "Medical Examination of the Rape Victim - Gynecology and Obstetrics - MSD Manual Professional Edition".
  7. 7.0 7.1 "www.who.int" (PDF).
  8. Vickerman KA, Margolin G (July 2009). "Rape treatment outcome research: empirical findings and state of the literature". Clin Psychol Rev. 29 (5): 431–48. doi:10.1016/j.cpr.2009.04.004. PMC 2773678. PMID 19442425.
  9. "Sexual Assault Infectious Disease Prophylaxis - StatPearls - NCBI Bookshelf".
  10. Saddichha S (April 2010). "Diagnosis and treatment of chronic insomnia". Ann Indian Acad Neurol. 13 (2): 94–102. doi:10.4103/0972-2327.64628. PMC 2924526. PMID 20814491.
  11. Meel BL (July 2005). "HIV/AIDS post-exposure prophylaxis (PEP) for victims of sexual assault in South Africa". Med Sci Law. 45 (3): 219–24. doi:10.1258/rsmmsl.45.3.219. PMID 16117282.
  12. Inciarte A, Leal L, Masfarre L, Gonzalez E, Diaz-Brito V, Lucero C, Garcia-Pindado J, León A, García F (January 2020). "Post-exposure prophylaxis for HIV infection in sexual assault victims". HIV Med. 21 (1): 43–52. doi:10.1111/hiv.12797. PMC 6916272 Check |pmc= value (help). PMID 31603619.


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