Sexually transmitted infectious diseases - procedures after sexual violence

The standardized medical first aid after a rape or sexual assault includes a clarification of sexually transmitted infectious diseases. This examination includes serological tests for syphilis, hepatitis B and HIV. If these tests are carried out within a few hours or days after the assault, they indicate the status prior to the assault, but not infections caused by the act itself (0 status).

Testing for trichomonas, gonorrhea and chlamydia is also recommended. It is important to note that the tests for sexually transmitted infections (STIs) must be consented to. 

After the initial examination, a schedule of follow-up examinations is recommended to check for the occurrence of pregnancy and STIs:

• After 1 week: tests for gonorrhea, chlamydia infection and trichomoniasis, especially for those who have not received prophylactic treatment.

• After 2 weeks: pregnancy test.

• After 4 to 6 weeks: Tests for syphilis and HIV.

• After 3 months: Tests for syphilis, hepatitis and HIV.

This schedule is intended to ensure that all possible consequences of rape or sexual assault are recognized and treated accordingly.

Regardless of 0 status, the WHO recommends offering prophylactic antibiotic treatment, taking into account locally prevalent infectious diseases (e.g. syphilis). If this is desired, the least complicated and shortest dosage form is recommended in order to increase the probability of taking the drug. 

The following aspects should be considered in the recommendation:

• Requested by the person concerned - no laboratory examination possible - low probability of re-presentation for follow-up examinations - high risk of infection, e.g. in index persons with a known STI Prophylactic therapy should at least cover C. trachomatis and N. gonorrhoeae, which represent the most common treatable STIs in Europe Prophylactic therapy in adolescents and adults (awmf guideline): Ceftriaxone 1-2 g i.m. or i.v. plus azithromycin 1.5 g p.o. Due to the low prevalence of trichomoniasis in Germany, the addition of metronidazole (2 g p.o. as a single dose) appears to be dispensable, but justified in individual cases.

In the case of emergency contraception with levonorgestrel or ulipristal acetate, metronidazole should be taken approx. 3 hours later due to the increased risk of nausea. In the case of laboratory-confirmed gonococcal infection, the specific treatment recommendations apply.

Until the final check-up, the use of barrier methods (condoms) during sexual intercourse should be recommended to prevent any further transmission.