With regards to post-exposure prophylaxis in the sexual assault victim (SAV), which of the following is true?
A. Post assault, there is a 5 day window in which HIV prophylaxis can be successfully initiated B. Standard STD prophylaxis should only be offered after all associated cultures have been processed C. The immediate use of an emergency contraceptive can drop the likelihood of becomming pregnant to < 15% D. Hepatitis B vaccine should be offered to all patients who have not been previously vaccinated
Hepatitis b vaccine should be offered to all patients who have not been previously vaccinated-to maximize the likelihood of success with post-sav hiv prophylaxis, treatment should be initiated as soon as possible and definitely within 72h of the event. with regards to std cultures, they are often expensive and offer no forensic value. as well, not all juristictions will automatically pay for this form of testing in the sav. given this, a more prudent course of action would entail empiric coverage for gc, chlamydia, and trichomonas (eg ceftriaxone 125mg im, azithromycin 1g po, and metronidazole 2g po). the immediate use of an emergency contraceptive can reduce the risk of pregnancy to 1-2%. hepatitis b vaccination is recommended for savs who have not been previously immunized. concurrent hepatitis b immunoglobulin administration is not necessary. (rosens 989-991)