Sexual Assault by eMRCOG
Sexual Assault by eMRCOG
Sexual Assault by eMRCOG
• The woman should be advised not to wash or wipe herself if she is considering a forensic medical examination
• She should also not eat, drink or pass urine prior to early evidence being collected
• An early evidence kit should be used to collect evidence and this is available in the emergency department.
• The contents of the kits vary but the minimum requirement is urine collection and a mouth rinse.
Pregnancy prevention
• Most screening for sexually transmitted infections should be done 2–3 weeks after the assault because of the
incubation time of pathogens
• Prophylaxis against bacterial sexually transmitted infections is rarely offered, but can be considered in those
whose risk of infection is high and who are unlikely to attend for follow-up.
• Blood tests at 3 months should be offered to screen for hepatitis B, syphilis and HIV.
• HIV post-exposure prophylaxis post-sexual assault (PEPSE) should be discussed with every woman.
• Unprotected anal intercourse carries the highest risk
• It is likely that the strength of recommendation and subsequent uptake will be higher when the assailant is
perceived to be from a high prevalence group, such as a man from sub-Saharan Africa, a man who has sex with
men or a man who is an intravenous drug user PEPSE should be started as soon as possible, but within 72
hours and continued for 4 weeks
• An accelerated course of hepatitis B vaccine should be offered (at 0, 1, 3 weeks or 0, 1, 2 months with a booster
at 12 months in either course).
Vulnerable populations
• Gillick competence should be assessed in everyone below 16 years of age or below 18 years if they have
learning difficulties
• Staff involved in the care of these women should assess the risk of domestic violence. This may be done by using
the DASH (domestic abuse, stalking and ‘honour’- based violence) risk check list And, in turn, considering a
multi-agency risk assessment conference (MARAC) referral.
Forensic evidence
• The SARC model has been promoted by the Home Office as the gold standard of care for victims of sexual
assault.
• the SARC may offer a forensic medical examination with collection of DNA and other evidence without the police
being involved, giving the woman the opportunity to consider her options and report the assault at a later date.
• Forensic specimens should only be collected if the clinician has specialist training in this area, therefore is not
within the remit of a gynaecologist on call.
• In general, swabs can be taken up to 7 days after vaginal penetration, 3 days after anal penetration and 2 days
after oral penetration
• A toxicology screen will be sent from blood within 3 days of the assault and from urine within 14 days of the
assault if a drug-facilitated sexual assault is suspected
Follow-up
• All women should be offered follow-up care arranged in a genitourinary medicine clinic, with their GP or possibly
at a local SARC .
• The follow-up appointment should be arranged before the starter pack of PEPSE medication finishes (usually 3–5
days)
• Baseline bloods are carried out in this initial appointment, if not already done
reference :
Tog article
____________________________________________________
Join us For January 2021 preparation and revision Courses (( join Today and get the Last minute Discount ))