Sexual Assult

Clinical Description

DEFINITION: Non-consensual sexual act.

• Refer to SGBV guidelines for more information

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)

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 o <25 kg: 600 000IU stat, o 25 – 35 kg: 1,200,000 IU stat; o 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