Prophylaxis After Sexual Assault

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


Weight> 45 kg and <150kg: 

500 mg IM x 1 dose 


1000 mg IM x 1 dose 


100 mg enterally bid x 7 days 


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 


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.

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.