Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Name the blood tests, urine tests and cultures that should be obtained from the victim 2. List the medications for STD prophylaxis
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Sexual assault is unfortunately not an uncommon event, with the National Intimate Partner and Sexual Violence Survey providing a statistic of 1.3 million rape-related physical assaults per year. Some centers have a team trained and available to identify and assist rape victims. However, this is not universal and women’s healthcare providers may be either part of such a team, or may be the initial point of contact and care provider. Important points to consider are as follows:
Ask for help if not familiar with performing an examination as proper evidence collection is necessary to prosecute a case
Tell a sexual assault victim, if outside the hospital or clinic, to come to a medical facility directly and avoid bathing, cleansing, eating, changing her clothes, urinating, defecation, washing her mouth, cleaning her fingernails, smoking, eating or drinking
Obtain history including circumstances of the attack, patient activities after the attack (including bathing, douching), last menstrual period, contraceptive history, previous coitus
Noting genital and nongenital trauma, foreign material (stains, hair, dirt, etc) colposcopy if available
Collect samples of clothing, hair, semen, blood from the patient
Collect urine, saliva, buccal mucosa smear, fingernail clipping and scraping, other specimens as indicated
Vaginal test for acid phosphatase, saline mount for sperm, trichomonads, bacterial vaginosis, semen analysis for blood group
Initial STD exam (CDC)
NAATs for C. trachomatis and N. gonorrhoeae at the sites of penetration or attempted penetration
NAATs from a urine or vaginal specimen or point-of-care testing (i.e., DNA probes) from a vaginal specimen for T. vaginalis
Point-of-care testing and/or wet mount with measurement of vaginal pH and KOH application for the whiff test from vaginal secretions should be done for evidence of BV and candidiasis, especially if vaginal discharge, malodor, or itching is present
NAAT also available for BV and candidiasis
A serum sample for evaluation of HIV, hepatitis B, and syphilis infections.
STD prophylaxis (CDC)
Test and provide and empiric antimicrobial treatment for chlamydia, gonorrhea and trichomoniasis
Note: Gonorrhea is now treated with ceftriaxone 500mg IM for individuals weighing <150kg, and 1g for individuals weighing 150kg
Assailant HepB status unknown and survivor is unvaccinated
HepB vaccine without HBIG
Assailant HepB positive and survivor is unvaccinated
HepB vaccine and HBIG
At initial exam
1-2 months and 4-6 months after first dose
If survivor previously vaccinated but did not receive postvaccination testing
single vaccine booster
HPV vaccination is recommended for female survivors aged 9–26 years and male survivors aged 9–21 years
Administer vaccine to sexual assault survivors at the time of the initial examination with follow-up dose administered at 1–2 months and 6 months after the first dose
HIV Prophylaxis (PEP)
Best if started as soon as possible after penetration | Do not give if >72 hours
Preferred PEP regimen (4 weeks)
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily plus
Raltegravir 400 mg PO twice daily or Dolutegravir 50 mg PO daily
CDC guidance (see ‘Learn More – Primary Sources Below) provides further regimen considerations when
Source in known to be HIV-infected | Dose adjustments for renal insufficiency | Drug-drug interactions | Recommended alternative regimens
Urine for drug screen and pregnancy
Offer emergency contraception (see ‘Related ObG Topics’ below)
Repeat pregnancy test in 2 weeks
Nearly 20% of women report having been raped at some time in their lives, according to the CDC 2010 survey. Goals of the rape investigation include: medical assessment and treatment; pregnancy and STD prevention/treatment; collection of forensic data; and psychologic evaluation and support. A form is used to record legal evidence and findings. This may be introduced in court, so should be legible and nontechnical. Some states have programs with designated hospitals, training sites and forensic examiners.
Psychologic support should be started at presentation; the full effects may not be evident initially
Follow-up is important and ideally handled by a specialist trained in rape crisis intervention
STD Follow Up
If initial tests negative and no treatment
Repeat STD tests within 1–2 weeks of the assault
If treated during the initial visit (regardless of whether testing was performed)
Only do post-treatment testing if symptomatic
Follow up exam at 1–2 months to look for anogenital warts
Repeat serologic tests for syphilis if initial test results were negative and infection in the assailant cannot be ruled out
Repeat serologic tests for syphilis at 4–6 weeks and 3 months
Repeat at 6 weeks and at 3 and 6 months using methods to identify acute HIV infection
Offer emergency contraception (see ‘Related ObG Topics’ below)
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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