Sexually Transmitted Infections (STIs)

• Examiners should provide patients with information about the potential risk of  transmission of sexually transmitted infections, along with the symptoms and treatment. Some factors affecting the transmission of STIs include the type and nature of the assault, the extent of the injuries, the number of assaults, the number of perpetrators, susceptibility of the patient, and known STI status of the perpetrator(s). A discussion should occur regarding baseline treatments options along with follow up care and referrals.
• The need for baseline testing for STIs should be considered on a case by case basis by both examiners and patients. Testing at the time of the initial exam does not typically have forensic value if patients are sexually active and a STI could have been acquired prior to the assault. Testing at the time of the exam, however, provides examiners the opportunity to recommend specific treatment and allows patients the option of deferring treatment until it is needed. If baseline testing is performed, the guidelines outlined by the Centers for Disease Control and Prevention (CDC) should be followed. Obtaining specimens for STI testing should be performed immediately following forensic specimen collection.
• Prophylaxis against STIs at the time of the exam should be discussed with patients, and may be indicated for those patients who decline baseline testing and for those patients who may not attend a follow-up appointment or referral. Patients who prefer prophylaxis generally do not require baseline testing. Prophylaxis may include medications for trichomoniasis, bacterial vaginosis, gonorrhea, and chlamydial infections since they are the most frequently diagnosed infections among sexually assaulted women. Prophylactic treatment should additionally be based upon any clinical presentation that may suggest a preexisting STI. Therapy should be based upon CDC recommended medications and doses.

Hepatitis B Virus (HBV)

• Examiners should provide patients with information regarding HBV. Patients who have completed a full Hepatitis B vaccination regimen prior to the assault are generally protected from HBV infection and may not require further doses. For those patients who have not received the vaccination regimen, have not completed the regimen or are unsure, the regimen should be initiated at the exam along with follow up referrals for two additional doses given at one to two months and again at four to six months following the initial dose. If perpetrators are suspected or known to have Acute Hepatitis B, it may be advisable to administer Hepatitis B Immunoglobulin. Treatment should be based upon CDC recommended doses.