Prophylaxis After Sexual Assault | Infectious Diseases Management Program at UCSF

Patient Population:

Pediatric

This and other STI sections are not meant to be comprehensive references for all STI treatment but primarily focused on the most commonly used initial empiric antimicrobial therapy. Users should refer to linked resources (SFDPH City Clinic protocols, CDC guidelines) or other local resources to provide patients and their partners appropriate counseling and follow-up. For non-adolescent age patients, patients with STIs not addressed in these guidelines, or patients with contraindications to the listed therapies, we recommend referring to the linked resources, or Lexi-Comp for medication information, or consulting ID/ASP for individualized recommendations.  

Condition	Major Pathogens	First Choice Therapy	Alternative Therapy	Comments
Sexual assault	Multiple possible exposures (including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, Treponema pallidum, HBV)	For postpubertal adolescents: Ceftriaxone Weight> 45 kg and <150kg: 500 mg IM x 1 dose Weight>=150kg: 1000 mg IM x 1 dose AND Doxycycline 100 mg enterally bid x 7 days AND Metronidazole 500 mg enterally bid x 7 days Consider HIV post-exposure prophylaxis	Pregnancy not ruled out: Replace Doxycycline with Azithromycin 1000 mg enterally  x 1 dose Penicillin or cephalosporin allergy with higher risk for allergic reaction: Omit Ceftriaxone from regimen, monitor, test & treat for gonorrhea as clinically indicated	Refer to facility specific HIV post-exposure prophylaxis guidelines (BCH OAK) or to national guidelines Assistance can be obtained by calling the National Clinician’s PEP hotline Perform pregnancy testing and provide emergency contraception when appropriate Review hepatitis B and HPV vaccination status and need for repeat vaccination or HBIG

Condition

Major Pathogens

First Choice Therapy

Alternative Therapy

Comments

Sexual assault

Multiple possible exposures (including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, Treponema pallidum, HBV)

For postpubertal adolescents:

Ceftriaxone

Weight> 45 kg and <150kg:

500 mg IM x 1 dose

Weight>=150kg:

1000 mg IM x 1 dose

AND

Doxycycline
100 mg enterally bid x 7 days

AND

Metronidazole
500 mg enterally bid x 7 days

Consider HIV post-exposure prophylaxis

Pregnancy not ruled out:

Replace Doxycycline with Azithromycin 1000 mg enterally  x 1 dose

Penicillin or cephalosporin allergy with higher risk for allergic reaction:
Omit Ceftriaxone from regimen, monitor, test & treat for gonorrhea as clinically indicated

Refer to facility specific HIV post-exposure prophylaxis guidelines (BCH OAK) or to national guidelines

Assistance can be obtained by calling the National Clinician’s PEP hotline

Perform pregnancy testing and provide emergency contraception when appropriate

Review hepatitis B and HPV vaccination status and need for repeat vaccination or HBIG

References: 

American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021. 

Workowski KA, et al. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70:1-187.

St. Cyr S, et al. Update to CDC’s treatment guidelines for gonococcal infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916.

Sexually Transmitted Infections