Ceftriaxone₃500 mg IM once if <150 kg body weight 1 gm IM once if >150 kg body weight
Doxycycline100 mg PO q12h for 7 days
Ceftriaxone₃ AND AzithromycinFor pregnant patients
★
Ceftriaxone₃500 mg IM once if <150 kg body weight 1 gm IM once if >150 kg body weight
Azithromycin1 gm PO once
OR
500 mg on day 1, followed by 250 mg once daily for the next 4 days (Z-Pak)
Gentamicin AND AzithromycinFor cephalosporin allergic patients
Gentamicin240 mg IM once
Azithromycin2 gm PO once
Cefixime₃ AND DoxycyclineOnly if ceftriaxone administration is not available or not feasible; higher risk of treatment failure for pharyngeal infections
Cefixime₃800 mg PO once
Doxycycline100 mg PO q12h for 7 days
Cefixime₃ AND AzithromycinOnly if ceftriaxone administration is not available or not feasible; higher risk of treatment failure for pharyngeal infections
Cefixime₃800 mg PO once
Azithromycin1 gm PO once
OR
500 mg on day 1, followed by 250 mg once daily for the next 4 days (Z-Pak)
MetronidazoleFor pregnant and non-pregnant patients
★???
A single 2-gram dose is likely a better choice if adherence to a 7-day treatment regimen is a concern; some suggest these higher doses should NOT be given in the first trimester of a pregnant patient
Estrogen-EE and Levonorgestrel-LNG (Yuzpe regimen)Less effective, more side effects, low cost
Ethinyl Estradiol (EE)100 mcg PO q12h for 2 total doses
Levonorgestrel (LNG)0.5 mg PO q12h for 2 total doses
Copper IUDMost effective form of emergency contraception
Can be placed within 120 hours of sexual assault Not likely feasible in the Emergency Department Provides 10 years of birth control Cannot be given with active Gonorrhea and/or Chlamydia infections
Recombivax HB®
Ages 18 & 19 5 mcg (0.5 mL) IM HBsAg at 0, 1, and 6 months
Age ≥20 10 mcg (1 mL) IM HBsAg at 0, 1, and 6 months
Immunocompromised and/or Hemodialysis and Age ≥20 Dialysis formulation 40 mcg (1 mL) IM HBsAg at 0, 1, and 6 months
Engerix-B®
Ages 18 & 19 5 mcg (0.5 mL) IM HBsAg at 0, 1, and 6 months
Age ≥20 10 mcg (1 mL) IM HBsAg at 0, 1, and 6 months
Immunocompromised and/or Hemodialysis and Age ≥20 Engerix B does NOT have a dialysis formulation; requires double dose (i.e. 40 mcg total); Recombivax HB is simpler to give and fewer follow-up visits for this patient population 40 mcg (2 mL) IM HBsAg at 0, 1, 2, and 6 months
Heplisav-B®
Age ≥18 20 mcg (0.5 mL) IM HBsAg at 0 and 1 months
PreHevbrio®
Age ≥18 10 mcg (1 mL) IM HBsAg at 0, 1, and 6 months
HepaGam B® or HyperHEP B® or Nabi-HB®Deltoid and/or Anterolateral Aspects of the Upper Thighs
0.06 ml/kg IM (max 2 mL per site)
Gardasil 9®
Not Vaccinated or First Dose ≥15 Years Ensure 3 dose series 0.5 mL IM at 0, 1-2, and 6 months
Not Vaccinated or First Dose <15 Years Ensure 2 dose series 0.5 mL IM x2 at least 5 months apart
Tenofovir Disoproxil Fumarate (TDF) + Emtricitabine (FTC) aka Truvada®/GenericTDF 300 mg + FTC 200 mg PO q24h (one tablet) for 28 days
Darunavir (DRV) aka Prezista®800 mg PO q24h for 28 days
Ritonavir (RTV) aka Norvir®100 mg PO q24h for 28 days
Hep B PEP Algo
CDC Hepatitis B post-exposure prophylaxis for sexual assault survivors — driven by assailant HBsAg status, the survivor's vaccination history, and their antibody response.
HIV establishes infection very quickly, often within 24–36 hours. PEP must start within 72 hours.
TLDR
Management of sexual assault involves addressing physical injuries, offering prophylaxis for sexually transmitted infections (STIs) and pregnancy, and providing emotional support. A detailed history and forensic evidence collection are performed if the patient consents. Prophylaxis includes medications to prevent infections and pregnancy as appropriate. Emotional and mental health care is essential, with referrals for counseling or crisis intervention.
Follow-up ensures comprehensive support for the patient's medical and psychological recovery.
The CDC recommends consultation for all pregnant and pediatric patients at the National Clinician's Post Exposure Prophylaxis Hotline: 888-448-4911; consider calling your hospital pharmacist outside of the hotline hours.