Adult Sexual Assault

Overview

  • People who have been sexually assaulted should be treated in a manner which best respects and allows control over their own bodies.
  • Sexual assault is very common and may increase sexual risk taking behaviours and potential STI exposure.
  • Most positive baseline testing will be from pre-existing infection.
  • The evidentiary value of STI testing to determine source transmission is limited at present due to current testing methods.

Testing advice

InfectionConsideration
HIV Baseline testing. Follow up test at 6 weeks and 12 weeks.
Samples and their results taken at baseline and subsequently may be legally presentable.
Consider referral for post-exposure prophylaxis if seen within 72 hours of exposure.
Syphilis Baseline testing. Follow up in 6 weeks and 12 weeks. If clinical suspicion of syphilis, refer to the syphilis guideline.
Hepatitis B Baseline testing. Repeat HBsAg at 6 weeks and 12 weeks if anti-HBs negative.
Consider hepatitis B immunoglobulin if non-immune, no history of vaccination or unknown status. This should be given within 72 hours of potential exposure, along with the hepatitis B vaccine within 14 days.
Ensure vaccination schedule is completed if needed.
Chlamydia Test any orifice which has been penetrated. Consider
self-collection of samples for testing.
Initial screening and repeat after 2 weeks or earlier if symptomatic.
NAAT is highly sensitive and may detect early infection as a result.
Gonorrhoea Test any orifice which has been penetrated. Consider
self-collection of samples for testing.
Initial screening and repeat after 2 weeks or earlier if symptomatic.
NAAT is highly sensitive and may detect early infection as a result.
If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment.
Trichomoniasis Initial screening and repeat after 2 weeks or earlier if symptomatic.
NAAT is highly sensitive and may detect early infection as a result.
HBsAg – Hepatitis B surface antigen
Anti-HBs – Hepatitis B surface antibody
NAAT – Nucleic Acid Amplification Test

Specimen collection

Clinician collected | 
Self-collection

Clinical indicators for testing

  • Test all people presenting following sexual assault whether or not symptomatic.
  • Individuals may be experiencing a loss of memory or have an uncertain history.
  • Test all people who request testing.
  • It is not recommended to routinely test for herpes and genital warts with serology. Consider testing for herpes and genital warts only if there are clinical signs and symptoms.

Special considerations

  • Consider provision of hepatitis B and HIV post-exposure prophylaxis immediately following sexual assault.
  • Discuss and offer emergency contraception to females who are at risk of becoming pregnant.
  • Discuss and offer pregnancy testing and referral for termination services for women, depending on the time since assault.
  • Patients who have been sexually assaulted should be treated in a manner which best respects control over their own bodies. This may mean delaying testing or the use of self-collected samples.
  • If symptomatic, consider testing for other STIs or other infective causes (e.g. herpes, mycoplasma genitalium, candidiasis, bacterial vaginosis).

Follow up

Make arrangements for the provision of results to the person.

If test results are positive, refer to STI management section for advice on:


Even if all test results are negative, use the opportunity to:

  • Keep a clear line of communication between the healthcare worker and the person
  • Provide referral for follow up of their psychological health and counselling
  • Educate about condom use and risk minimisation
  • Vaccinate for hepatitis B, if susceptible
  • Discuss and activate reminders for regular screening tests according to risk, especially if their behaviours indicate the need for more frequent testing.

Auditable outcomes

STI testing is offered at baseline or at follow-up for 100% of cases of adult sexual assault.

Last Updated: Monday, 14 January 2019