Aim We have reviewed 4 years of PEPSE use in our SARC and its follow-up and compared with BASHH guidance on PEPSE after sexual assault.
Methods Retrospective review of SARC and GUM notes from 12 October 2007 to 12 October 2011
Results 1233 cases seen 127 given PEPSE, for two notes not available Age range 14–55 years mean 27. 81% were female. 51% were vulnerable. Ethnicity of assailants, 81 White European, 20 African, 5 Asian, 4 Dark European, 13 unknown. One man had PEPSE twice. Mean time till received PEPSE was 25 h range 3–168 h, 5 over 72 h. Using BASHH guidelines PEPSE was recommended in 22%, considered in 50% and 26% was not recommended as either >72 h or low risk exposures. 87 returned at day 3 for review. 29 stopped PEPSE early. One was HIV positive at baseline, 12 due to side-effects, three felt the assault was low risk of HIV at review, 13 for other reasons. 27% returned for HIV test at 3 months, 14% at 6 months. No seroconversions seen. 17% completed PEPSE. 43 given PEPSE while on interacting drugs. Eight were identified and given appropriate management. Most common interaction was hormonal contraception.
Discussion Completion rates for PEPSE were low and similar low rates have been seen in alike studies. No long-term side effects were seen but only 19% of interactions were identified. PEPSE is a risk reduction method and so clients should not be put at risk of serious drug interactions. 33 were given PEPSE for low risk exposures which is “not recommended” by BASHH. 10 of these accepted full PEPSE course. The decision to start PEPSE is often made under stressful conditions so GUM now review need for PEPSE after completing the starter pack. It is vital staff starting PEPSE prescribe within the guidelines and they and GUM staff consider interactions. We have created a proforma which reminds staff only to give within 72 h and review interactions. It also outlines HIV risks after exposure and hopefully make it easier to discuss this with the client.