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A regional audit was undertaken to evaluate current practice in the management of survivors of sexual assault (SA) seen in genitourinary (GU) medicine clinics in the North Thames. The majority of the survivors were women. Most were fast-tracked, or seen in dedicated SA clinics. Over 60% of staff had specific training in management of SA. Core services provided included screening and treatment for sexually transmitted infections, emotional support, emergency contraception and hepatitis B vaccination. The sexual health needs of these survivors of SA are being met by most clinics. The development and use of a standardized care proforma across the region may be a means to further improve the care provided.
Int J STD AIDS 2007 Jan
PMID:Management of rape/sexual assault cases within genitourinary medicine clinics: results from a study in North Thames. 1732 66

No indicator reliably predicts if a woman has gonorrhea or chlamydia (sexually transmitted diseases [STDs]) during an Emergency Department (ED) visit. Before culture results return, emergency physicians (EPs) must choose whom to treat. We evaluated EP treatment of STDs within our institution. EPs voluntarily completed anonymous surveys while evaluating women requiring both a pelvic examination and STD cultures, except for sexual assault victims. The questionnaires asked for patients' demographics, history, physical examination, and in-ED laboratory tests, and whether any particular section of the encounter caused treatment. The treated and untreated groups' characteristics, as reported by the examining physicians, were compared. There were 145 questionnaires returned over a 6-month period; 41/145 patients (28%) were treated for presumed STD-28 (68%) based on physical examination, 8 (19.5%) on history, and 5 (12.5%) on in-ED laboratory tests. Comparison of treated vs. untreated groups revealed no difference in patient demographics. The treated group had more historical positives (3.92 vs. 2.84, respectively; p < 0.001) and physical examination findings (3.39 vs. 1.24, respectively; p < 0.001) compared to the untreated group. Eleven patients (7.58%) had positive STD cultures, 4 (9.75%) in the treated group and 7 (6.73%) in the untreated group (p > 0.05). In our institution, EPs chose to treat patients with more historical and physical examination findings, not based on demographics. Our EPs' presumptive STD treatment paradigms do not accurately distinguish patients with positive pelvic culture results from those with negative results, supporting the available literature that describes the difficulty of this diagnosis. Individual EDs must recognize this infection identification problem and, after assessment of their treatment population, institute either a liberal presumptive STD treatment regimen for all comers, or establish reliable and timely follow-up for women left untreated.
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PMID:Emergency physicians' patterns of treatment for presumed gonorrhea and chlamydia in women: one center's practice. 1824 22

Survivors of sexual assault can access treatment and care within genitourinary (GU) medicine services by attending walk-in, booked or a dedicated clinic. Haven Whitechapel the local Sexual Assault Referral Centre (SARC) provides a forensic and aftercare service. A team was set up to ensure efficient communication and clear referral pathways between the centres. This service was audited after eight months of joint working. A retrospective case note review of women attending between August and March 2007 was undertaken. Sixty-nine women were referred to the dedicated clinic. Vaginal rape was reported by 80% of the women. Offer of forensic medical examination documented in 71% presenting within the forensic timeframe. Emergency contraception was offered to 75% of the women. HIV-acquisition risk was documented in 70%. Seventy-eight percent had a sexually transmitted infection screen at their first visit. An HIV test was done to 41% of the women; all were found to be negative. Sixty-two percent women attended follow-up. GU medicine staff should receive specific training in sexual assault. We recommend that GU medicine services and SARC work in partnership to improve the care of victims of sexual assault who access general GU medicine services.
Int J STD AIDS 2008 Jul
PMID:Management of survivors of sexual assault within genitourinary medicine. 1857 23

Mental health issues following sexual assault in young people are common but early intervention may improve outcome. A retrospective case-note review of 58 female patients aged between 13 and 18 attending The Haven Whitechapel, a sexual assault referral centre, demonstrated past emotional problems in 72% of those seen, and current emotional problems in 95% of those being followed up. Fifteen percent were already involved with adolescent mental health services (AMHS). All patients requiring and not already receiving input were referred to AMHS or in-house. Of 23 patients referred to AMHS, eight (35%) were accepted and the patients attended, seven (30%) were accepted but did not attend, six (26%) were declined and the outcome of two referrals was unknown. The prevalence of emotional problems and inconsistent referral outcomes demonstrate a need for closer links with AMHS, clearer referral criteria and improved referral pathways.
Int J STD AIDS 2008 Aug
PMID:Referral of young people attending a sexual assault referral centre to mental health services. 1866 45

Chain of evidence (COE) sampling is a legal concept demonstrating the journey of a sample from origin to court. Positive sexually transmitted infection (STI) results may have importance in criminal proceedings and require a demonstrated COE for them to be used as admissible evidence. A retrospective case-notes review of female sexual assault patients was carried out to review COE sampling in two clinics. Three hundred and eighteen patients underwent sexual health screening and COE sampling was indicated in 58 (18%). COE sampling was carried out in 44 (92%) of 48 indicated cases at the Haven (a dedicated sexual assault centre) and five (50%) of 10 at the Ambrose King Centre (a sexual health clinic). COE protocols should be in place in both sexual assault referral centres and sexual health clinics. In specialist clinics, with well-established guidelines and trained dedicated staff, COE sampling standards can be achieved.
Int J STD AIDS 2009 Nov
PMID:Chain of evidence in sexual assault cases. 1983 96

The aim of this study is to gain an understanding of the services available to subjects of sexual assault at genitourinary medicine (GU medicine) clinics throughout the United Kingdom, and to determine whether these services are adequate. By means of a questionnaire, consultants in 106 clinics provided information on the number of patients who reported sexual assault and the services available to them. The study found a marked regional variation in attendances by subjects of sexual assault. However, only a minority of clinics kept accurate data (36.7% regarding female victims and 37.75% regarding male victims). The number of subjects who were aged under 16 years was disproportionately high (under 16s: 6.9% of female victims and 1.2% male victims; 16 and over: 1.3% of female victims and 0.14% of male victims). This survey highlights deficiencies in services that need to be addressed by clinics, management and the speciality.
Int J STD AIDS 2010 May
PMID:Availability of services for subjects of sexual assault in genitourinary medicine clinics. 2118 68

Provincial guidelines for HIV non-occupational postexposure prophylaxis (NPEP) were implemented on January 2005 in Alberta, Canada. Human immunodeficiency virus (HIV) NPEP was provided free of charge following approval by a medical officer of health. Between 1 January 2005 and 30 June 2007, 174 individuals were prescribed NPEP; 135 (78%) were women with a median age of 24 years. Sexual assaults accounted for 68% of exposures. NPEP was completed in 49% of cases. Individuals who completed NPEP were less likely to have been exposed by sexual assault (P = 0.04) and more likely to have received HIV follow-up testing (P = 0.03).Individuals who received at least one HIV follow-up test were older (P = 0.03) and more likely to have been exposed percutaneously (P = 0.003). Those who received no follow-up testing were less likely to have filled an NPEP prescription (P = 0.0001). New strategies are required to improve follow-up of individuals receiving NPEP, especially younger persons or sexual assault survivors.
Int J STD AIDS 2010 Sep
PMID:HIV non-occupational postexposure prophylaxis in a Canadian province: treatment completion and follow-up testing. 2109 33

The purpose of the study was to assess the use of sexual and reproductive health services by adolescents aged 15 years and younger. A case-note review was conducted at both a genitourinary medicine clinic and a family planning clinic in Edinburgh, UK. The demographics of the attendees, reasons for attending, risk factors, diagnostic tests undertaken and contraceptive advice given differed between the two clinics. Approximately 73% of attendees with documented responses used alcohol and 21% used recreational drugs, 5% reported self-harm, 25% reported being victims of sexual assault, 13% had a current sexually transmitted infection and 6% of girls had already been pregnant. While this group of young people understand the differences in emphasis between the clinics, adolescents may be intimidated and discouraged from attending or may fail to return, and the combination of overlap, together with omissions in cross-clinic function, suggests that for this age group the services of these clinics should be combined.
Int J STD AIDS 2010 Sep
PMID:A comparison of sexual and reproductive health services provided by genitourinary and family planning clinics for adolescents. 2109 38

An audit of all patients presenting to an inner city sexual health clinic post-sexual assault over a four-year period was undertaken to evaluate the overall management of these patients. Sixty-five cases were identified; 22.6% had a pre-existing vulnerability factor and 21.0% a sexually transmitted infection (STI). Recommendations from the audit included: to offer non-invasive methods of testing for STIs to patients presenting at less than one week, improve documentation by completing the specific clinic template and ensure all patients are offered emotional support when they first attend.
Int J STD AIDS 2011 May
PMID:Management of patients seen post-sexual assault at a north London inner city genitourinary medicine clinic 2005-2008. 2157 78

An audit of 72 patients presenting for post-exposure prophylaxis following sexual exposure (PEPSE) to HIV (68 genitourinary medicine and 4 accident & emergency) was conducted from 2003 to 2009. The principal indications for PEPSE included 27 (38%) unprotected intercourse (15/27 vaginal and 12/27 anal) with a known HIV-positive partner, 20 (28%) unprotected receptive anal sex with male partner of unknown status, 17 (24%) following sexual assault and three (4%) unprotected sex with a partner from an endemic country. Of those who commenced PEPSE, 92% did so within the recommended 72 hours. Concurrent sexually transmitted infection (STI) was diagnosed in 8.3% patients (6.9% non-gonococcal urethritis and 1.4% rectal chlamydia). Fifty (69%) patients attended for follow-up and only 8% of these did not complete treatment. Twenty-five (35%) patients attended for repeat serology at three months and 18 (25%) at six months. All of the patients followed up remained HIV-negative.
Int J STD AIDS 2011 Jul
PMID:Post-exposure prophylaxis following sexual exposure to HIV: a seven-year retrospective analysis in a regional centre. 2172 62


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