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ital infections (GI)
Special situation: sexual violence
T aking into consid eration th e ph ysical, psych olog ical, leg al and social consequences of
sexual v iolence, medical care is not lim ited to th e d iag nosis and treatm ent of g enital
lesions or infections.
Care includ es listening to th e v ictim ‟s story, a com plete ph ysical exam ination,
laboratory tests if av ailable, and com pletion of a m ed ical certificate (see Practical advice
for writing medical certificates in the event of sexual violence, pag e 312).
During th e consultation, proph ylactic or curativ e treatm ents m ust be proposed to th e
patient.
– P roph ylactic treatm ent:
• priority is g iv en to th e risk of HIV transm ission (earliest possible antiv iral th erapy
for patients seen w ith in 48-72 h ours after exposure, see HIV infection and AIDS,
pag e 207) and to th e risk of preg nancy resulting from rape (ad m inister em erg ency
contraception as soon as possib le, id eally w ith in 72 h ours of exposure:
levonorgestrel P O : one 1500 µg tablet or two 750 µg tablets as a sing le3d ose) ;
• prev ention of sexually transm itted infections includ es a sing le d ose treatm ent with
azith rom ycin 1 g + cefixim e 400 m g . If necessary, treatm ent of trich om oniasis m ay
follow;
• tetanus proph ylaxis and /or v accination (see Tetanus, pag e 170) if th ere are any
wound s;
• v accination ag ainst h epatitis B (see Viral hepatitis, accelerated vaccination schedule,
pag e 200).
– Curativ e treatm ent:
• of wound s,
• of any related path olog ies/infections if th e assault is not recent.
M ental h ealth care is necessary irrespectiv e of any d elay between th e ev ent and th e
patient arriv ing for a consultation. Care is based on im m ed iate attention (one-on-one
reception and listening ) and if necessary, follow-up care with a v iew to d etecting and
treating any psych olog ical and /or psych iatric sequelae (anxiety, d epression, post-
traum atic stress d isord er, etc.). S ee Ch apter 11.
3 Genital infections may be sexually transmitted (e.g. gonorrhoea, chlamydia) or not (e.g. most cases of
candidiasis).
230
Special situation: sexual violence
T aking into consid eration th e ph ysical, psych olog ical, leg al and social consequences of
sexual v iolence, medical care is not lim ited to th e d iag nosis and treatm ent of g enital
lesions or infections.
Care includ es listening to th e v ictim ‟s story, a com plete ph ysical exam ination,
laboratory tests if av ailable, and com pletion of a m ed ical certificate (see Practical advice
for writing medical certificates in the event of sexual violence, pag e 312).
During th e consultation, proph ylactic or curativ e treatm ents m ust be proposed to th e
patient.
– P roph ylactic treatm ent:
• priority is g iv en to th e risk of HIV transm ission (earliest possible antiv iral th erapy
for patients seen w ith in 48-72 h ours after exposure, see HIV infection and AIDS,
pag e 207) and to th e risk of preg nancy resulting from rape (ad m inister em erg ency
contraception as soon as possib le, id eally w ith in 72 h ours of exposure:
levonorgestrel P O : one 1500 µg tablet or two 750 µg tablets as a sing le3d ose) ;
• prev ention of sexually transm itted infections includ es a sing le d ose treatm ent with
azith rom ycin 1 g + cefixim e 400 m g . If necessary, treatm ent of trich om oniasis m ay
follow;
• tetanus proph ylaxis and /or v accination (see Tetanus, pag e 170) if th ere are any
wound s;
• v accination ag ainst h epatitis B (see Viral hepatitis, accelerated vaccination schedule,
pag e 200).
– Curativ e treatm ent:
• of wound s,
• of any related path olog ies/infections if th e assault is not recent.
M ental h ealth care is necessary irrespectiv e of any d elay between th e ev ent and th e
patient arriv ing for a consultation. Care is based on im m ed iate attention (one-on-one
reception and listening ) and if necessary, follow-up care with a v iew to d etecting and
treating any psych olog ical and /or psych iatric sequelae (anxiety, d epression, post-
traum atic stress d isord er, etc.). S ee Ch apter 11.
3 Genital infections may be sexually transmitted (e.g. gonorrhoea, chlamydia) or not (e.g. most cases of
candidiasis).
230
