Medical

Medical Management

Hospital

Access to medical interventions within 72 hrs is highly recommended to reduce the risk of contracting HIV.

Pregnancy prevention

In view of the psychological consequences of conceiving after being raped, every non pregnant woman/girl should be offered emergency contraception (EC). It can be given up to 72 hours after rape but it is more effective the sooner it is given.Ideally an anti emetic should be offered with the EC, to reduce the chances of vomiting. It should be explained to the woman that EC is to prevent pregnancy and is NOT a form of abortion as termination of pregnancy may be unacceptable to some people.

HIV prevention

For many survivors of sexual assault the thought of becoming HIV infected can greatly add to their psychological distress. The actual risk of HIV infection without intervention is difficult to quantify but it is thought to be considerably higher than from unprotected consensual sex as a result of violent penetration results in both microscopic and visible mucosal tears.Post Exposure Prophylaxis (PEP) is the administration of one or a combination of Anti Retroviral Drugs (ARV’S) for 28 days after the exposure to HIV.

Management of physical injuries

This is dependent on the age of survivors. Ideally children should be admitted and examined under anesthesia or given first aid and then referred. Abrasions and superficial lacerations should be cleaned with antiseptic and either dressed or painted with tincture of iodine. A virginal wash with an appropriate antiseptic should be done AFTER all specimens have been taken.

Prophylaxis/management of sexually transmitted infections

STI prophylaxis should be offered to all rape survivors. It need not be given at the same time as the initial doses of PEP or EC as the pill burden can be intolerable. It should preferably be prescribed for the client and given for uptake within 24 hours.

Hepatitis B prevention

The general available Hepatitis B vaccines do not provide any protection from infection if given after an exposure but they do provide protection from future exposures. Administration of the toxoid does however provide some protection, after the exposure has occurred.The lack of proper documentation means that even the minority of cases that get to court are often thrown out because of lack of evidence. It is vital that the examination causes the absolute minimum of added trauma that is possible. All bruises, abrasion, teeth marks to the head, mouth, mouth, neck, breast, perineum, anus and vagina should be documented carefully in the clinical notes in the post rape care form 1(PRC1) available in all health facilities.This allows the P3 form to be filled effectively, preferably by the person performing the examination (this is not always possible). The PCR1 form should be filled in duplicate and the original and the original given to the client while the copy is left for facility records.