Treatment

Treating Victims

If you suspect a patient may be a victim of a drug-facilitated sexual assault:

• The patient should be treated with respect and with a non-judgmental approach.
• Offer to have the police involved.
• In some cases, such as if the victim is under 16 or if they were abused by a current partner or family member and are still in danger, you may be required to report the assault to authorities. Consult local police or sex crimes unit for more information.
• If the patient does not meet the above criteria, police may allow the victim to determine whether an investigation is performed or if charges are laid. Drug testing and forensic examinations can sometimes be performed even before a victim has made these decisions.
• Advise the patient not to bathe, shower or change his or her clothes. These tips can help preserve evidence if the victim reports to police.
• If drugging is suspected, victim should avoid urinating before a sample can be collected.
• Standard drug testing can be arranged. Depending on the presentation of the patient, police involvement and additional testing for Flunitrazepam and GHB should be considered.
• Also offer a forensic examination at an accredited centre. Contact regional police for advice and centre locations.
• Offer testing for Sexually Transmitted Infections including samples required for the rape kit as well as serology for HIV, Syphilis, Hepatitis B & C.
• Offer antibiotic prophylaxis.
• The patient should be tested to exclude pre-existing pregnancy where this is appropriate.
• A patient should be offered emergency contraception where there is a risk of pregnancy.
• Referral to a sexual assault crisis center, social worker, psychologist or psychiatrist.
• Offer follow-up screening for Sexually Transmitted Infections as well as psychological support.

Table 2. Sexual Assault Care Prophylaxis: presenting within 72 hours 

Contributor: Nathalie Fleming, MD