Survivors of sexual assault
are at risk for acquiring sexually transmitted infections (STIs). We conducted
literature reviews and invited experts to assist in updating the sexual assault
section for the 2015 Centers for Disease Control and Prevention sexually
transmitted diseases (STD) treatment guidelines.
New recommendations for STI
management among adult and adolescent sexual assault survivors include use of
nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis
by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia
trachomatis from pharyngeal and rectal specimens among patients with a history
of exposure or suspected extragenital contact after sexual assault; empiric therapy
for gonorrhea, chlamydia, and trichomoniasis based on updated treatment
regimens; vaccinations for human papillomavirus (HPV) among previously
unvaccinated patients aged 9-26 years; and consideration for human
immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an
algorithm to assess the timing and characteristics of the exposure.
For child
sexual assault (CSA) survivors, recommendations include targeted diagnostic
testing with increased use of NAATs when appropriate; routine follow-up visits
within 6 months after the last known sexual abuse; and use of HPV vaccination
in accordance with national immunization guidelines as a preventive measure in
the post-sexual assault care setting. For CSA patients, NAATs are considered to
be acceptable for identification of gonococcal and chlamydial infections from
urine samples, but are not recommended for extragenital testing due to the
potential detection of nongonococcal Neisseria species.
Several research
questions were identified regarding the prevalence, detection, and management
of STI/HIV infections among adult, adolescent, and pediatric sexual assault
survivors.
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By:
- 1Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill.
- 2Division of STD Prevention, Bureau of Infectious Diseases, Massachusetts Department of Public Health, Jamaica Plain.
- 3Division of Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio.
- 4Division of Child Protection Pediatrics, Department of Pediatrics, University of Texas Health Science Center at Houston.
- 5Child Abuse and Neglect Prevention, Children's Hospital of Philadelphia, Pennsylvania.
- 6Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Massachusetts Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston.
- 7Women's Emergency Services, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.
- 8Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston.
- 9Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle.
- 10Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn.
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