Pediatric emergency medicine trisk 4244 4244
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vaccination is recommended for female survivors aged 9–26 years and male survivors aged 9–
21 years. For MSM with who have not received HPV vaccine or who have been incompletely
vaccinated, vaccine can be administered through age 26 years. The vaccine should be administered to
sexual assault survivors at the time of the initial examination, and follow-up dose administered at 1–2
months and 6 months after the first dose.
The rationale for HIV PEP assumes a window of time in which the viral
load can be controlled by the immune system. The addition of antiretroviral
medications during this window may then stop replication. Although a
definitive statement of benefit cannot be made regarding PEP after sexual
assault, the possibility of HIV exposure should be assessed at the time of the
postassault examination. If PEP is offered to a patient, it is important to
discuss the relative risks and benefits of antiretroviral medications, the
importance of close follow-up, and, strict adherence to the recommended 28day dosing regimen to inform the patient and caregiver about PEP. PEP
should be given within 72 hours of the assault and is more effective if given
as soon as possible following the exposure. Providers should emphasize that
PEP is usually well tolerated and serious adverse effects are rare. If initiating
PEP, specialist consultation is recommended regarding treatment if a local
protocol is not established. No large studies examining different treatment
regimens have been performed with sexual assault victims, but on the basis
of current occupational-exposure guidelines, two nucleoside reversetranscriptase inhibitors and one of either a nonnucleoside reversetranscriptase inhibitor or protease inhibitor for 4 weeks are typically
recommended. Since these medications may not be readily available at some
pharmacies, patients in whom PEP is initiated must be given a minimum of a
3- to 5-day supply of PEP at discharge. A follow-up visit or some method of
care coordination should be scheduled for several days after the initial visit
to allow for additional counseling, to assure that the patient has filled the
prescription and to assess tolerance of medications. Prior to initiating PEP,
depending upon the drug regimen used, a complete blood cell count,
electrolytes, BUN, creatinine, liver transaminases should be performed for
baseline levels as well as an HIV antibody test.
Pregnancy Prophylaxis
Emergency contraception should be offered to every pubertal female.
Consent includes risks of prophylaxis and failure, and options for pregnancy
