Pediatric emergency medicine trisk 4242 4242
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vaccinated against Hepatitis B should receive the Hepatitis B vaccination,
without Hepatitis B immunoglobulin (HBIG). If the assailant is known to be
HBsAg-positive, victims should be given both Hepatitis B vaccine and
HBIG with follow-up vaccine doses at 1 to 2 months and 4 to 6 months after
the first dose. Finally, consider Hepatitis C testing based on risk assessment
of assault.
HPV vaccination is also recommended for male victims 9 to 21 years of
age and female victims aged 9 to 21 who were unvaccinated prior to the
acute sexual assault. Follow-up HPV vaccination dosing is recommended at
1 to 2 months and 6 months after the first dose. HPV vaccination reduces
risk of infection with human papillomavirus. Remember, the HPV
vaccination is contraindicated in pregnant women and in those with an
allergy to yeast. A negative HCG should be obtained prior to administering
this vaccination.
HIV Prophylaxis
HIV prophylaxis is not universally recommended because although HIV
seroconversion has occurred in people whose only risk factor was sexual
assault, the frequency of this occurrence is extremely low. Several factors
impact the medical recommendation for HIV postexposure prophylaxis
(PEP). These include the likelihood of the assailant having HIV; any
exposure characteristics that might increase the risk for HIV transmission
based on type of sexual contact (e.g., single episode vs. multiple/chronic),
time elapsed after the event, and the potential benefits and risks associated
with PEP. Most often, an assailant’s HIV status at the time of the assault
examination is unknown. It is therefore important to consider any known
HIV-risk behaviors of the perpetrator, local epidemiology of HIV/AIDS, and
exposure characteristics of the assault. Higher-risk exposures include vaginal
or anal receptive intercourse, forceful intercourse, ejaculation on any
mucous membrane, history of multiple assailants, and whether mucosal
lesions are present in the assailant or patient.
