Rationale:

• Most sexual assault response team programs do not routinely do STD testing.
• STD testing during sexual assault examination can only detect preassault infection and provides no meaningful information for the crime lab.
• The routine prophylactic treatment with antibiotics effective against gonococcus and chlamydia makes detection of these preexisting infections superfluous.
• Clinicians may want to consider obtaining cultures from patients who are minors and unable to consent to intercourse, in whom the presence of an STD would indicate abuse.
• Testing for HIV and hepatitis B is recommended because the efficacy of prophylactic treatment is not complete and seroconversion attributed to the assault may qualify the patient to have all related medical expenses resulting from seroconversion covered by the victims of violent crime compensation fund.
• Many centers choose to refer patients for HIV and hepatitis B testing rather than doing it on site because follow-up treatment for these patients is poor and communicating positive test results may be problematic.
• Antibiotics effective against incubating syphilis include ceftriaxone and cefixime; the role of serologic testing becomes less important when these drugs are given.

Evidence:

• Most of the 110 U.S. sexual assault response team programs surveyed by telephone in a study published in 2006 do not routinely perform STD genital testing, but 96% of the programs do administer antibiotics to prevent gonococcus and chlamydia all or most of the time. Only 14% of programs performed serologic testing for HIV all or most of the time (43).
• Most (88%) of the 25 female sexual assault patients who were offered antibiotics completed therapy in a small retrospective chart review of its acceptability (44).

Comments:

• None.