Sexual Assault

Investigations

General measures

Medicine treatment

---

ICD-10 code: T74.2 + (Y05.0-99)

INVESTIGATIONS

• Urine pregnancy test.
• Blood for:
  - Syphilis serology
  - HIV
  - Hepatitis B if no history of previous Hep B immunisation

GENERAL MEASURES

• Trauma counselling and completion of J88 forms.
• Examination under anaesthesia may be required for adequate forensic sample collection, or repair of genital tract trauma.

MEDICINE TREATMENT

Emergency contraception:

ICD-10 code: (Z29.8)

• Do a pregnancy test in all women and female adolescents.
• Children must be tested and provided with emergency contraception from Breast Tanner Stage III.
• If unsure of staging, give Emergency contraception in the presence of any breast development (DO NOT REGARD MENARCHE AS AN INDICATION).
• Copper IUCD, e.g.:
  • Cu T380A, inserted as soon as possible after unprotected intercourse and not later than 5 days.

LoE:IIIb^xxxv 

OR 

• Levonorgestrel 1.5 mg, oral, as a single dose as soon as possible after unprotected intercourse, and not later than 5 days.
  • If the person vomits within 2 hours, repeat the dose.

 LoE:Ia^xxxvi

---

Note:
- Advise women that the emergency contraception should not affect their usual menstrual cycle: very rarely it is delayed but it should not be more than 7 days late. If this occurs, they should come back for a pregnancy test.

---

CAUTION
- Emergency contraceptive tablets must be taken as soon as possible, preferably within 72 hours of unprotected intercourse, and not later than 5 days.
- Enzyme inducers (including efavirenz, carbamazepine, and rifampicin) cause a significant reduction in levonorgestrel concentrations. Women on these medicines should preferably have copper IUCD inserted or alternatively double the dose of levonorgestrel.
- Women weighing > 80 kg or with a BMI ≥ 30 should also preferably have copper IUCD inserted, or alternatively, double the dose of levonorgestrel.

LoE:IIIb^xxxvii

---

If there is vomiting:

ICD-10 code: (Z29.8)

• Metoclopramide oral, 10 mg 8 hourly or as needed.

LoE:IVb

STI prophylaxis:

ICD-10 code: (Z29.8)

• Ceftriaxone, IM, 250 mg as a single dose.
  • For ceftriaxone IM injection: Dissolve ceftriaxone 250 mg in 0.9 mL lidocaine 1% without adrenaline (epinephrine).

AND

• Azithromycin, oral, 1 g, as a single dose.

LoE:IIIb^xxxviii

AND

• Metronidazole, oral, 2 g immediately as a single dose.

HIV post-exposure prophylaxis (PEP):

ICD-10 code: (Z20.6+Z29.8)

See: Non-occupational post exposure prophylaxis, inadvertent non-occupational.

Click here for the pdf

---

Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 5: Gynaecology; Version 1.0, 2020-4_June 2024