Background Chlamydia trachomatis and Neiserria gonorrhoea screening following sexual assault is undertaken primarily for sexual health purposes but can potentially facilitate criminal investigation in cases of penetration at sexually naive sites. Antibiotic prophylaxis at first attendance (within 7 days of the assault) is not routine but may be given when the return for screening is unlikely.
Aim To improve bacterial STI screening and management in complainers attending our sexual assault referral centre (SARC).
Objectives To determine if complainers were adequately screened for bacterial STIs and if communication with health professionals regarding repeat screening was adequate.
To review prophylactic antibiotic use.
To review the forensic significance of STI screening.
To identify factors which may improve the uptake of screening.
Methods 100 case records were reviewed and information relevant to our objectives extracted. Six cases were excluded.
Results 81% had a STI screen taken at presentation. Only 13% returned for repeat screen after incubation, confirming Chlamydia in two cases. All but one repeat screen correlated to the site of exposure. GPs were informed of the need for a repeat screen in 74% of cases. 59% had an alert sited on their sexual health record highlighting the need for a repeat screen. Antibiotic prophylaxis was given in 25 cases with reasons documented in only 4.
Discussion and/or Conclusion STI screening post sexual assault may be improved through better communication with complainers and other healthcare providers. Improvements to communication methods and training are required to facilitate this. The concern of emerging gonococccal resistance should be considered prior to administering prophylactic antibiotics. One individual, in whom there was no previous sexual contact and baseline screen was negative, had Chlamydia on repeat sample. This may be supportive of the assailant as the source of infection, indicative of the potential forensic role of STI screening.
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