Management of Rape Victims

1
Management of Rape Victims

• Martin Donohoe
• Information within does not constitute clinical
  advice regarding treatment I recommend
  consulting contemporary medical references

2
Rape

• Unwanted, forced penetration (oral/vaginal/anal)
• reported by 33 - 46 of women who are physically
  abused
• annual incidence ³ 80/100,000 women
• 7 of all violent crimes
• lifetime prevalence 10 - 25

3
Date Rape

• 40 of college women report forced sexual
  contact, attempted rape, or completed rape
• independent of school demographics

4
Date Rape

• gt25 of college males admit to using sexually
  coercive behaviors
• 2/3 of college males report engaging in unwanted
  sexual intercourse
• reasons peer pressure, desire to be liked

5
Spousal Rape

• 10 - 15 of all marriages
• more violent, less frequently reported then
  non-spousal rape
• not illegal in many U.S. states/other countries

6
High Risk Groups

• Prostitutes
• Military
• See the Womens Health and War and Peace
  pages of the Public Health and Social Justice
  website for other slide shows and articles
  covering
• Violence against women in the military
• War, rape and genocide
• Homeless and runaways

7
High Risk Perpetrators

• Male college athletes
• Fraternity members
• Men with restraining orders

8
Rape

• 5 chance of pregnancy
• 25 chance of acquiring STD
• GC 6 - 12
• Chlamydia 4 - 17
• Syphilis 0.5 - 3
• 1 -2/1,000 odds of acquiring HIV
• varies

9
Rape

• 5 chance of pregnancy
• 25 chance of acquiring STD
• GC 6 - 12
• Chlamydia 4 - 17
• Syphilis 0.5 - 3
• 1 -2/1,000 odds of acquiring HIV
• varies

10
Rape

• Underreported (42 never come to attention of
  authorities)
• Less than 1 of rapists convicted
• Large backlog of untested rape kits (over
  180,000)
• H.R. 4114 and S.B 2736 (Justice for Survivors of
  Sexual Assault) bills pending in Congress

11
Rape

• Average prison time for those convicted
• rape 1 year
• armed robbery 3 - 5 years
• murder 8 years
• Chemical Castration Laws

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The Physicians Duties in Caring for Victims of
Sexual Assaults

• Medical
• medical history
• evaluate and treat physical injuries
• cultures
• treat pre-existing infections
• NEJM 1995 332234-7

13
The Physicians Duties in Caring for Victims of
Sexual Assaults

• Medical
• offer post-exposure HIV prophylaxis
• offer post-coital contraception (vs. in utero
  paternity testing f/b selective abortion)
• arrange medical followup
• provide counseling
• NEJM 1995 332234-7

14
Physical Examination ofSexual Assault Victims

• Collection of clothing
• External evaluation
• abrasions, lacerations, ecchymoses, bite marks
• Oral cavity
• secretions, injuries, cultures
• NEJM 1995 332234-7

15
Physical Examination ofSexual Assault Victims

• Genitalia
• hair combing, hair sampling, vaginal secretions,
  injuries, cultures
• Rectum
• injuries, cultures
• NEJM 1995 332234-7

16
Prophylaxis for Adult Victims ofSexual
AssaultAntibiotic Prophylaxis

• Ceftriaxone (250 mg IM) or Spectinomycin (2 g IM)
• PLUS
• Doxycycline (100 mg po bid x 7d) or Azithromycin
  (1 g po x 1)
• PLUS
• Metronidazole ( 2 g po x 1)

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Prophylaxis for Adult Victims ofSexual
AssaultPrevention of Pregnancy

• Most effective regimen 1 dose of 1.5 mg
  levonorgestrel or 2 doses of 0.75 mg
  levonorgestrel taken 12 (or up to 24) hours apart
• Alternate regimen 2 doses of 100 mcg ethinyl
  estradiol plus 0.5 mg levonorgestrel taken 12
  hours apart (plus prn antiemetic)

18
HIV Post-Exposure Prophylaxis for Adult Victims
ofSexual Assault

• HIV Prophylaxis
• Consult ID
• start up to 72 after rape
• Baseline HIV test and referral to experienced
  clinician within 72 hours of starting PEP

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Hepatitis B Post-Exposure Prophylaxis for Adult
Victims ofSexual Assault

• Offender HBsAg-positive administer Hep B vaccine
  and HBIG
• Offenders HBsAg status unknown administer Hep B
  vaccine
• Rx ideally within 24 hrs, but may be effective up
  to 14 days
• Complete Hep B vaccine series

20
Ensure Victims Safety

• Social worker involvement
• Restraining order
• Phone numbers of shelters, hotlines
• Safe place to go

21
Domestic Violence Shelters

• Availability poor
• up to 70 - 80 of women and 80 of children
  turned away on any given night
• 4 times as many animal shelters as domestic
  violence shelters in U.S.

22
Domestic Violence Shelters

• Woefully underfunded
• Average length of stay 14 days most allow 30
  day max stay
• Over 50 of all homeless women and children are
  fleeing domestic violence

23
Contact Information

• Public Health and Social Justice Website
• http//www.phsj.org
• martindonohoe_at_phsj.org