Rationale:

• The CDC has made recommendations for HIV prophylaxis in patients assaulted by a known HIV-positive perpetrator.
• Some authorities recommend initiation under specific other high-risk circumstances if candidates are willing to take the full course and comply with follow-up testing.
• If a sexual assault nurse examiner or other experienced forensic examiner is not available in a timely fashion and the treating physician fails to do a forensic examination and provide appropriate treatment, valuable evidence and necessary treatment will be compromised.
• Most jurisdictions only allow for forensic evidence to be collected for 72 hours after assault, and it is best collected as soon as immediately possible.
• The efficacy of postcoital contraception declines with increasing postcoital intervals and becomes entirely ineffective after approximately 7 days.
• The efficacy of STD prophylaxis declines with increasing postcoital intervals and is not recommended for some medications if more than 72 hours have elapsed.

Evidence:

• Only 15% of sexual assault cases led to charges being filed against the perpetrator in one case series of 888 patients evaluated in the emergency department. Data from that series support the association of a physical examination within 24 hours of the assault and the presence of anogenital trauma with the filing of charges (88).
• The CDC review of HIV prophylaxis in nonoccupational exposure (sexual contact) in 2005 did not definitively recommend for or against antiretroviral agents in situations other than those in which the perpetrator was known to be HIV positive because of a lack of data (74).
• State guidelines concerning HIV prophylaxis in sexual assault are available from many sources that can be found in this 2003 review on the topic (89).

Comments:

• None.