Unfortunately you will care for children and adolescents who are victims of sexual assault in the Emergency Department. If an adolescent is the victim of a sexual assault prophylaxis against common sexually transmitted infections is recommended. You will certainly want to consider allergy status, immunization status (Hepatitis B), and local epidemiology and resistance of STIs in your treatment plan.

Overall the most common STIs following sexual assault are; gonorrhea, chlamydia, trichomoniasis, and bacterial vaginosis in women. In men it is gonorrhea and chlamydia. If you are endeavoring to cover gonorrhea, chlamydia, and trich you would administer the following;

Ceftriaxone 500mg IM in a single dose, for persons ≥150 kg give 1g of ceftriaxone

AND

Doxycycline 100mg 2 times/day orally for 7 days

AND

Metronidazole 500mg orally 2 times/day orally for 7 days

If you are concerned that the patient will be unable to fill and or complete the course of doxycycline for chlamydia you could go with a single oral dose of 1g dose of Azithromycin, but the current CDC recommendations note increased resistance and advocate for doxycycline instead. If a patient is unimmunized or partially immunized against hepatitis B consider giving a single booster dose of the vaccine could be given. Ideally post-exposure prophylaxis for human immunodeficiency virus is given if an exposure occurred within the past 72 hours – but fortunately seroconversion to HIV positive status is very rare after a single sexual assault. Obviously if the perpetrator is known to be HIV positive then HIV post-exposure prophylaxis should be started. Prophylaxis against herpes simplex virus infection isn’t generally necessary, and there is no existing evidence to suggest that starting antivirals is efficacious. Syphilis prophylaxis decisions depend on patient history and local disease prevalence.

References

Updated Guidelines for Antiretroviral Postexposure Prophylaxis after Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV – United States, 2016. MMWR Morb Mortal Wkly Rep, 2016. 65(17): p. 458.

Seña AC, Hsu KK, Kellogg N, Girardet R, Christian CW, Linden J, Griffith W, Marchant A, Jenny C, Hammerschlag MR. Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children. Clin Infect Dis. 2015 Dec 15;61 Suppl 8:S856-64. doi: 10.1093/cid/civ786. Review. PubMed PMID: 26602623.

CDC Sexual Assault and Abuse and STIs – Adolescents and Adults. https://www.cdc.gov/std/treatment-guidelines/sexual-assault-adults.htm