1. Management of Rape Victims
Martin Donohoe
Information within does not constitute clinical advice regarding treatment – I recommend consulting contemporary medical references

2. Rape Unwanted, forced penetration (oral/vaginal/anal)
Reported by % of women who are physically abused

3. Rape Annual incidence ³ 80/100,000 women 7% of all violent crimes
Lifetime prevalence up to 25%
1/3 Native Americans/Alaskan Natives victims of attempted rape or rape
Migrants, those in war zones and refugee camps at high risk

4. Rape Annual incidence of at least 300,000 women in US
Forcible rape every 6.2 seconds (FBI)
7% of all violent crimes
Additional 3.7 million confronted with unwanted sexual activity
Lifetime prevalence 13-39% in women; 3% in men

5. Epidemiology of VAW 2011 CDC study
18% of women have been raped; 1.4% of men
Women: 52% by partner; 41% by acquaintance
Men: 52% by acquaintance; 15% by stranger

6. independent of school demographics
Date Rape
40% of college women report forced sexual contact, attempted rape, or completed rape
independent of school demographics

7. Date Rape
>25% of college males admit to using sexually coercive behaviors
2/3 of college males report engaging in unwanted sexual intercourse
reasons: peer pressure, desire to be liked

8. Spousal Rape 10 - 15% of all marriages
more violent, less frequently reported then non-spousal rape
not illegal in many U.S. states/other countries

9. High Risk Groups Prostitutes Military
See the “Women’s Health” and “War and Peace” pages of the Public Health and Social Justice website for other slide shows and articles covering:
Violence against women in the military
War, rape and genocide
Homeless and runaways

10. High Risk Groups Gays, lesbians, bisexuals, transgendered
Alcohol and drug users
College students
Persons under age 24

11. “High Risk” Perpetrators
Male college athletes
Fraternity members
Men with restraining orders

12. Rape 5% chance of pregnancy 25% chance of acquiring STD GC = 6 - 12%
Chlamydia = %
Syphilis = %

13. Rape 5% chance of pregnancy 25% chance of acquiring STD GC = 6 - 12%
Chlamydia = %
Syphilis = %

14. Rape and HIV 1 -2/1,000 odds of acquiring HIV from HIV+ rapist
1-2/100,000 overall risk of HIV from vaginal penetration
2-3/10,000 from anal penetration

15. Rape and Pregnancy
Noninvasive prenatal genetic testing through amplification of fetal alleles from maternal blood very accurate for identifying father
Can be performed at 8-14 weeks gestation
vs. amniocentesis and chorionic villus sampling (10-15 weeks, risks to mother and fetus)
May assist mother’s decision to carry vs. terminate pregnancy

16. Rape
Underreported (16-38% notify law enforcement; 17-43% present for medical evaluation)
Fewer than ½ of rape cases successfully prosecuted; as few as 1% of rapists convicted

17. Rape Large backlog of untested rape kits (over 180,000)
H.R and S.B 2736 (Justice for Survivors of Sexual Assault) bills pending in Congress

18. Rape Average prison time for those convicted: rape = 1 year
armed robbery = years
murder = 8 years
Chemical Castration Laws

19. The Physician’s Duties in Caring for Victims of Sexual Assaults
Medical
medical history
evaluate and treat physical injuries
cultures
treat pre-existing infections
NEJM 1995; 332:234-7 and NEJM 2011;365:834-41

20. The Physician’s Duties in Caring for Victims of Sexual Assaults
Medical
offer post-exposure HIV prophylaxis
offer post-coital contraception (vs. in utero paternity testing f/b selective abortion)
arrange medical followup
provide counseling
NEJM 1995; 332:234-7 and NEJM 2011;365:834-41

21. Physical Examination of Sexual Assault Victims
Collection of clothing
External/internal evaluation
abrasions, lacerations, ecchymoses, bite marks; colposcopy, toluidine blue staining
Oral cavity
secretions, injuries, cultures
Note: time limits for evidence collection vary by state ( hrs)
NEJM 1995; 332:234-7 and NEJM 2011;365:834-41

22. Physical Examination of Sexual Assault Victims
Genitalia
hair combing, hair sampling, vaginal secretions, injuries, cultures
Rectum
injuries, cultures
NEJM 1995; 332:234-7 and NEJM 2011;365:834-41

23. Prophylaxis for Adult Victims of Sexual Assault Antibiotic Prophylaxis
Ceftriaxone (250 mg IM) or cefixime (2 g po)
PLUS
Doxycycline (100 mg po bid x 7d) or Azithromycin (1 g po x 1)
Metronidazole ( 2 g po x 1)

24. Prophylaxis for Adult Victims of Sexual Assault Prevention of Pregnancy
Most effective oral regimen: 1 dose of 30 mg ulipristal or 1.5 mg levonorgestrel within 120 hours of unprotected intercourse (ulipristal twice as effective; 0.9% pregnancy rate vs 1.7%)

25. Most effective: IUD implanted within 5 days
Prophylaxis for Adult Victims of Sexual Assault Prevention of Pregnancy
Alternate regimen: 2 doses of 100 mcg ethinyl estradiol plus 0.5 mg levonorgestrel taken 12 hours apart (plus prn antiemetic)
Most effective: IUD implanted within 5 days
Nearly 100% effective

26. HIV Post-Exposure Prophylaxis for Adult Victims of Sexual Assault
HIV Prophylaxis
Consult ID
start up to 72° after rape
Baseline HIV test and referral to experienced clinician within 72 hours of starting PEP

27. Hepatitis B Post-Exposure Prophylaxis for Adult Victims of Sexual Assault
Offender HBsAg-positive: administer Hep B vaccine and HBIG
Offender’s HBsAg status unknown: administer Hep B vaccine
Rx ideally within 24 hrs, but may be effective up to 14 days
Complete Hep B vaccine series
Tetanus booster if indicated

28. Ensure Victim’s Safety
Social worker involvement
Restraining order
Phone numbers of shelters, hotlines
Safe place to go

29. Domestic Violence Shelters
Availability poor
up to % of women and 80% of children turned away on any given night
4 times as many animal shelters as domestic violence shelters in U.S.

30. Domestic Violence Shelters
Woefully underfunded
Average length of stay = 14 days; most allow 30 day max stay
Over 50% of all homeless women and children are fleeing domestic violence

31. Public Health and Social Justice Website
Contact Information
Public Health and Social Justice Website