Sexual Assault Medication Prophylaxis (Red Book)
Antimicrobial prophylaxis2 is recommended to include an empiric regimen to prevent Chlamydia trachomatis infection, gonorrhea, trichomoniasis, and bacterial vaginosis
|For gonorrhea3||Ceftriaxone, 125 mg, intramuscularly, in a single dose |
ORCefixime, 400 mg orally, in a single dose
ORCiprofloxacin, 500 mg, orally, in a single dose
OROfloxacin, 400 mg, orally, in a single dose
ORLevofloxacin, 250 mg, orally, in a single dose
|For C trachomatis infection||Azithromycin, 1 g, orally, in a single dose |
ORDoxycycline, 100 mg, orally, twice a day for 7 days (for those >= 8 years of age and not pregnant)
|For trichomoniasis and bacterial vaginosis||Metronidazole, 2 g, orally, in a single dose |
|For hepatitis B virus infection||Hepatitis B virus immunization at time of initial examination, if not fully immunized. Follow-up doses of vaccine should be administered 1-2 and 4-6 mo after the first dose. |
|For human immunodeficiency virus infection2||Consider offering prophylaxis for HIV, depending on circumstances (see Table 3.27, p 394)|
Plan B (levonorgestrel 0.75 mg), 2 tablets at the same time
Oral contraceptive pills each containing 20 or 30 µg of ethinyl estradiol plus levonorgestrel 0.1 mg or 0.15 mg or 0.3 mg norgestrel: each of 2 doses must be given 12 h apart. Each dose must contain at least 100-120 µg of ethinyl estradiol and 0.5 to 0.6 mg levonorgestrel or 1 mg norgestrel.
An antiemetic (eg, meclizine, 25-50 mg, once before the first dose of oral contraceptive)
1 Source: Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines - 2006. MMWR Recomm Rep. 2006; in press (see www.cdc.gov/mmwr)
2 See text for discussion of prophylaxis for human immunodeficiency virus (HIV) infection after sexual abuse or assault.
3 A single dose of a fluoroquinolone can be used in areas of low prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae. Because of resistance, fluoroquinolones should not be used if infection is acquired in Asia, the Pacific Islands (including Hawaii), California, and other areas with increased fluoroquinolone-resistant N gonorrhoeae. Quinolones should not be used in pregnant women.
4 The patient should have a negative pregnancy test result before emergency contraception is given. Although emergency contraception is most effective if taken within 72 hours of event, data suggest it is effective up to 120 hours.