Sexual Assault

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DEFINITIONNon-consensual sexual act. 

  • Refer to SGBV guidelines for more information. 

CLINICAL FEATURES 

SIGNS AND SYMPTOMS

  • Status of the clothes (torn, dirty, stains).
  • Visualize entire body to draw a detailed body map.
  • Note distinguishing features Mark abnormalities (i.e., contusions, scratches bites, ligature marks, old and new trauma).

INVESTIGATIONS

  • Physical examination
    • Include pertinent negatives. 
    • Pelvic exam: Visualize the external genitalia before using a speculum
    • Look for evidence of penetration (trauma especially around the introitus)
    • Speculum examination: look for evidence of trauma in the vagina and cervix
    • Take high vaginal swab
    • Negative findings do not exclude sexual assault.
  • Time-dependent specimens include sperm/semen, foreign material, swabs of body secretions and fingernail scrapings.
  • HIV counselling and testing
  • Urine pregnancy test (if positive pelvic scan to estimate gestational age)

Treatment 

PHARMACOLOGICAL

  • Manage physical effects of assault such as wounds, bruises
  • If victim has attained menarche and presents within 5 days after assault
    • Postinor-2: 2 pills stat or 1 pill 12 hours apart
    • OR Levonorgestrel 1.5 mg stat 
    • OR Microgynon 4 pills and repeat after 12 hours
    • OR Mifepristone 10mg stat
  • Presumptive treatment for STI
    • Benzathine penicillin
      • <25 kg: 600 000IU stat,
      • 25 – 35 kg: 1,200,000 IU stat;
      • adults: 2,400,000 IU stat IM
    • Gentamycin 6mg/kg or 240 mg IM Stat
    • Metronidazole 2g Stat or 5mg/kg every 8hrs for 7 days
    • Doxycycline 100 mg 12 hourly for 7 days
      • If pregnant or breastfeeding give Erythromycin
      • If <8 years’ Erythromycin 12.5 mg/kg 6 hourly for 7 days  
  • If HIV negative and within 72 hours
    • Provide PEP (Tenofovir/Lamivudine)
    • PEP (Tenofovir/Lamivudine/Dolutegravir) for children
  • Provide counselling on post-traumatic stress to victims and guardian
  • Assess safety for victims
  • Refer to other support services such as social worker, victim support unit in the police
  • Provide date for follow up
  • If pregnant
    • Conduct an obstetric scan for dating
    • Book antenatal care