Sexual assault - Revision history

Rossdonaldson1: /* Differential Diagnosis */

2025-01-16T00:48:19Z

Differential Diagnosis

← Older revision		Revision as of 00:48, 16 January 2025
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Lower GU trauma DDX}}		{{Lower GU trauma DDX}}
			{{Psychosocial DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 20:11, 3 August 2022

2022-08-03T20:11:06Z

← Older revision		Revision as of 20:11, 3 August 2022
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	==Background==		==Background==
			[[File:Vulva Figure 28 02 02.jpg\|thumb\|Labeled vulva, showing external and internal views.]]
			[[File:Blausen 0400 FemaleReproSystem 02b.png\|thumb\|Pelvic anatomy including organs of the female reproductive system.]]
	*Male victim in 10% of cases		*Male victim in 10% of cases
	*Toluidine blue: detects vulvar tears		*Toluidine blue: detects vulvar tears

Dieseldoc: /* Empiric Antibiotics for STDsUpdate to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6 */

2021-10-22T05:12:24Z

Empiric Antibiotics for STDsUpdate to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6

← Older revision		Revision as of 05:12, 22 October 2021
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	*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''		*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''
	**For pregnant patients, [[Azithromycin]] 1g orally in a single dose instead of doxycycline '''AND'''		**For pregnant patients, [[Azithromycin]] 1g orally in a single dose instead of doxycycline '''AND'''
	*[[Metronidazole]] 500 mg PO BID for 1 week		*[[Metronidazole]] 500 mg PO BID for 1 week '''AND'''
	*[[HIV post-exposure prophylaxis]]		*[[HIV post-exposure prophylaxis]]
	**Post-exposure prophylaxis (PEP) recommended as soon as possible if <= 72 hours since exposure AND		**Post-exposure prophylaxis (PEP) recommended as soon as possible if <= 72 hours since exposure AND

Dieseldoc: /* Empiric Antibiotics for STDsUpdate to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6 */

2021-10-22T05:11:48Z

Empiric Antibiotics for STDsUpdate to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6

← Older revision		Revision as of 05:11, 22 October 2021
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	*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''		*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''
	**For pregnant patients, [[Azithromycin]] 1g orally in a single dose instead of doxycycline '''AND'''		**For pregnant patients, [[Azithromycin]] 1g orally in a single dose instead of doxycycline '''AND'''
	*~~[[Metronidazole]] 2g orally in a single dose '''OR'''~~ [[Metronidazole]] 500 mg PO BID for 1 week ~~'''OR'''~~		*[[Metronidazole]] 500 mg PO BID for 1 week
	**[[Tinidazole]] 2g orally in a single dose
	*[[HIV post-exposure prophylaxis]]		*[[HIV post-exposure prophylaxis]]
	**Post-exposure prophylaxis (PEP) recommended as soon as possible if <= 72 hours since exposure AND		**Post-exposure prophylaxis (PEP) recommended as soon as possible if <= 72 hours since exposure AND

Dieseldoc: /* Empiric Antibiotics for STDsUpdate to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6 */

2021-10-22T04:51:05Z

Empiric Antibiotics for STDsUpdate to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6

← Older revision		Revision as of 04:51, 22 October 2021
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	*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''		*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''
	**For pregnant patients, [[Azithromycin]] 1g orally in a single dose instead of doxycycline '''AND'''		**For pregnant patients, [[Azithromycin]] 1g orally in a single dose instead of doxycycline '''AND'''
	*[[Metronidazole]] 2g orally in a single dose '''OR'''		*[[Metronidazole]] 2g orally in a single dose '''OR''' [[Metronidazole]] 500 mg PO BID for 1 week '''OR'''
	**[[Tinidazole]] 2g orally in a single dose		**[[Tinidazole]] 2g orally in a single dose
	*[[HIV post-exposure prophylaxis]]		*[[HIV post-exposure prophylaxis]]

Jfang: Links to gonorrhea/chlamydia/trichomonas pages

2021-02-09T03:39:59Z

Links to gonorrhea/chlamydia/trichomonas pages

← Older revision		Revision as of 03:39, 9 February 2021
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	*For patients who weigh > 45 kg, same as adult medications above		*For patients who weigh > 45 kg, same as adult medications above
	*For patients who weigh <= 45 kg		*For patients who weigh <= 45 kg
	**Gonorrhea: [[Ceftriaxone]] 50 mg/kg IM (maximum dose 250 mg) in a single dose		**[[Gonorrhea]]: [[Ceftriaxone]] 50 mg/kg IM (maximum dose 250 mg) in a single dose
	**Chlamydia: [[Doxycycline]] 2.2 mg/kg (maximum dose 100 mg) orally twice a day for 1 week		**[[Chlamydia]]: [[Doxycycline]] 2.2 mg/kg (maximum dose 100 mg) orally twice a day for 1 week
	***Doxycycline may be used in age < 8 for treatment durations <= 21 days<ref>CDC Research on doxycycline and tooth staining. https://www.cdc.gov/rmsf/doxycycline/index.html</ref><ref>		***Doxycycline may be used in age < 8 for treatment durations <= 21 days<ref>CDC Research on doxycycline and tooth staining. https://www.cdc.gov/rmsf/doxycycline/index.html</ref><ref>
	American Academy of Pediatrics Summary of Major Changes in the 2018 Red Book. https://redbook.solutions.aap.org/chapter.aspx?sectionid=189639927&bookid=2205</ref>		American Academy of Pediatrics Summary of Major Changes in the 2018 Red Book. https://redbook.solutions.aap.org/chapter.aspx?sectionid=189639927&bookid=2205</ref>
	***If patient is pregnant or liquid doxycycline is not available for patients who cannot swallow pills, can give [[Azithromycin]] 60 mg/kg (maximum dose 1000 mg) orally in a single dose		***If patient is pregnant or liquid doxycycline is not available for patients who cannot swallow pills, can give [[Azithromycin]] 60 mg/kg (maximum dose 1000 mg) orally in a single dose
	**Trichomonas: [[Metronidazole]] 15 mg/kg (maximum dose 670 mg or 2000 mg/day) orally three times a day for 1 week		**[[Trichomonas]]: [[Metronidazole]] 15 mg/kg (maximum dose 670 mg or 2000 mg/day) orally three times a day for 1 week

	===Vaccines<ref>CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm</ref>===		===Vaccines<ref>CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm</ref>===

Jfang: Formatting edit

2021-02-09T03:36:57Z

Formatting edit

← Older revision		Revision as of 03:36, 9 February 2021
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	*Consider [[emergency contraception]] if possibility of pregnancy		*Consider [[emergency contraception]] if possibility of pregnancy

	===Empiric Antibiotics for [[STDs]]~~===~~<ref>Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6</ref>		===Empiric Antibiotics for [[STDs]]<ref>Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6</ref>===
	[[File:Nonoccupational HIV algorithm.png\|thumb\|HIV nonoccupational exposure algorithm]]		[[File:Nonoccupational HIV algorithm.png\|thumb\|HIV nonoccupational exposure algorithm]]
	*[[Ceftriaxone]] 500mg IM in a single dose (1000mg if weight >= 150 kg) '''AND'''		*[[Ceftriaxone]] 500mg IM in a single dose (1000mg if weight >= 150 kg) '''AND'''
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	**Trichomonas: [[Metronidazole]] 15 mg/kg (maximum dose 670 mg or 2000 mg/day) orally three times a day for 1 week		**Trichomonas: [[Metronidazole]] 15 mg/kg (maximum dose 670 mg or 2000 mg/day) orally three times a day for 1 week

	===Vaccines~~===~~<ref>CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm</ref>		===Vaccines<ref>CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm</ref>===
	*[[Tetanus vaccine]]		*[[Tetanus vaccine]]
	*[[Hepatitis B post-exposure prophylaxis]]		*[[Hepatitis B post-exposure prophylaxis]]

Jfang: Added citation for adult STI medication changes

2021-02-09T03:35:37Z

Added citation for adult STI medication changes

← Older revision		Revision as of 03:35, 9 February 2021
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	*Consider [[emergency contraception]] if possibility of pregnancy		*Consider [[emergency contraception]] if possibility of pregnancy

	===Empiric Antibiotics for [[STDs]]===		===Empiric Antibiotics for [[STDs]]===<ref>Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. http://dx.doi.org/10.15585/mmwr.mm6950a6</ref>
	[[File:Nonoccupational HIV algorithm.png\|thumb\|HIV nonoccupational exposure algorithm]]		[[File:Nonoccupational HIV algorithm.png\|thumb\|HIV nonoccupational exposure algorithm]]
	*[[Ceftriaxone]] 500mg IM in a single dose (1000mg if weight >= 150 kg) '''AND'''		*[[Ceftriaxone]] 500mg IM in a single dose (1000mg if weight >= 150 kg) '''AND'''
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	**Trichomonas: [[Metronidazole]] 15 mg/kg (maximum dose 670 mg or 2000 mg/day) orally three times a day for 1 week		**Trichomonas: [[Metronidazole]] 15 mg/kg (maximum dose 670 mg or 2000 mg/day) orally three times a day for 1 week

	===Vaccines===		===Vaccines===<ref>CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm</ref>
	*[[Tetanus vaccine]]		*[[Tetanus vaccine]]
	*[[Hepatitis B post-exposure prophylaxis]]		*[[Hepatitis B post-exposure prophylaxis]]
	**Even if patient is vaccinated, give HBV vaccine booster shot, preferably within 24 hours of exposure~~<ref>CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm</ref>~~		**Even if patient is vaccinated, give HBV vaccine booster shot, preferably within 24 hours of exposure
	*HPV vaccine for female patients age 9-26 and male patients 9-21 if patient has not already completed series of 3 vaccines~~<ref>CDC 2015 Sexually Transmitted Diseases Treatment Guidelines. https://www.cdc.gov/std/tg2015/sexual-assault.htm</ref>~~		*HPV vaccine for female patients age 9-26 and male patients 9-21 if patient has not already completed series of 3 vaccines

Jfang: Added pediatric STI medication doses

2021-02-09T03:30:45Z

Added pediatric STI medication doses

← Older revision		Revision as of 03:30, 9 February 2021
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	*[[Ceftriaxone]] 500mg IM in a single dose (1000mg if weight >= 150 kg) '''AND'''		*[[Ceftriaxone]] 500mg IM in a single dose (1000mg if weight >= 150 kg) '''AND'''
	*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''		*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''
	**[[Azithromycin]] 1g orally in a single dose ~~for pregnant patients~~ '''AND'''		**For pregnant patients, [[Azithromycin]] 1g orally in a single dose instead of doxycycline '''AND'''
	*[[Metronidazole]] 2g orally in a single dose '''OR'''		*[[Metronidazole]] 2g orally in a single dose '''OR'''
	**[[Tinidazole]] 2g orally in a single dose		**[[Tinidazole]] 2g orally in a single dose
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	***Assailant HIV positive		***Assailant HIV positive
	***Assailant HIV status unknown, but patient's mucous membranes or non-intact skin exposed to blood, semen, vaginal secretions, or bloody body fluids		***Assailant HIV status unknown, but patient's mucous membranes or non-intact skin exposed to blood, semen, vaginal secretions, or bloody body fluids

			====Pediatric Antibiotics for [[STDs]]====
			*If patient is pre-pubertal, only treat with antibiotics if they test positive rather than empirically.
			*Pubertal patients should be given empiric antibiotics.
			*For patients who weigh > 45 kg, same as adult medications above
			*For patients who weigh <= 45 kg
			**Gonorrhea: [[Ceftriaxone]] 50 mg/kg IM (maximum dose 250 mg) in a single dose
			**Chlamydia: [[Doxycycline]] 2.2 mg/kg (maximum dose 100 mg) orally twice a day for 1 week
			***Doxycycline may be used in age < 8 for treatment durations <= 21 days<ref>CDC Research on doxycycline and tooth staining. https://www.cdc.gov/rmsf/doxycycline/index.html</ref><ref>
			American Academy of Pediatrics Summary of Major Changes in the 2018 Red Book. https://redbook.solutions.aap.org/chapter.aspx?sectionid=189639927&bookid=2205</ref>
			***If patient is pregnant or liquid doxycycline is not available for patients who cannot swallow pills, can give [[Azithromycin]] 60 mg/kg (maximum dose 1000 mg) orally in a single dose
			**Trichomonas: [[Metronidazole]] 15 mg/kg (maximum dose 670 mg or 2000 mg/day) orally three times a day for 1 week

	===Vaccines===		===Vaccines===

Jfang: Updated with new CDC STI treatment recommendations

2021-02-09T02:50:09Z

Updated with new CDC STI treatment recommendations

← Older revision		Revision as of 02:50, 9 February 2021
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	===Empiric Antibiotics for [[STDs]]===		===Empiric Antibiotics for [[STDs]]===
	[[File:Nonoccupational HIV algorithm.png\|thumb\|HIV nonoccupational exposure algorithm]]		[[File:Nonoccupational HIV algorithm.png\|thumb\|HIV nonoccupational exposure algorithm]]
	*[[Ceftriaxone]] ~~250mg~~ IM in a single dose '''AND'''		*[[Ceftriaxone]] 500mg IM in a single dose (1000mg if weight >= 150 kg) '''AND'''
	*[[Azithromycin]] 1g orally in a single dose '''AND'''		*[[Doxycycline]] 100mg orally twice a day for 1 week '''AND'''
			**[[Azithromycin]] 1g orally in a single dose for pregnant patients '''AND'''
	*[[Metronidazole]] 2g orally in a single dose '''OR'''		*[[Metronidazole]] 2g orally in a single dose '''OR'''
	**[[Tinidazole]] 2g orally in a single dose		**[[Tinidazole]] 2g orally in a single dose