Carefully consider giving medications that could alter a patient’s level of consciousness and affect their ability to consent to and participate in a sexual assault exam.
Pediatric recommendations (12 and younger)
Contact UAMS Team for Children at Risk to discuss
Adult/Adolescent (13+) STI Prophylaxis Recommendations
1st line recommendations based upon CDC current recommendations
2nd line are alternative options for allergies or concerns for non-adherence to 1st line regimen
Chlamydia:
1st line: Doxycycline 100mg BID x7days
2nd line: Azithromycin 1g PO x1dose
Gonorrhea:
1st line: Ceftriaxone 500mg IM x1 dose (increase to 1g if patient is >150kg)
2nd line: Gentamicin 240 mg IM PLUS 2g Azithromycin PO
Alternate option: Cefixime 800mg PO x1 dose
*From the CDC: If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100mg PO BID x7days
Trichomonas Vaginalis:
1st line: Metronidazole 500mg BID x7 days (Males: hold TV prophylaxis and test in 2-3 weeks)
2nd line: Metronidazole 2g PO x1 dose
Pregnancy Prevention:
Levonorgestrel 1.5mg PO within 72 hours of the assault
Ulipristal
Copper IUD placement
Lab Testing Recommendations
Pediatric Patients/ Adolescents with no history of prior voluntary sexual contact: Contact UAMS Team for Children at Risk via ACH Operation Center.
Adult/Adolescents:
Baseline serology testing: HIV, Hep. B, Hep. C, Syphilis (RPR)
Follow-up testing necessity and recommendations may vary based on patient population and type of contact. Adult standard recommendations are to re-test at 6 weeks, 3 months, and 6 months from assault.
Optional testing:
Gonorrhea, Chlamydia, Trichomonas Vaginalis
Testing for Gonorrhea, Chlamydia, and/or Trichomonas vaginalis during an acute sexual assault exam will not provide accurate results for STI acquisition from the assault, but is helpful for the assessment of overall patient health.
HIV nPEP
Prior to starting nPEP, patients should be counseled on the importance of strict adherence to the entire regimen.
Walgreens Community Pharmacy (specialty pharmacy in downtown Little Rock) can assist with getting nPEP medications to patients free of charge, even if they are using a Walgreens in a different town.
Business hours: 501-478-2655, ask to speak with a pharmacist about initiating nPEP
Adult recommendations:
Truvada (emtricitabine/tenofovir) 200mg/300mg PO qd x28 days
AND
Isentress (raltegravir) 400mg PO BID x28 days (use if pt is pregnant)
OR
Tivicay (dolutegravir) 50mg PO qd x28 days (use if patient is uninsured)
Pediatric recommendations:
Contact UAMS Team for Children at Risk via the ACH Operations Center