Sexual assault and intimate partner violence — trauma-informed ED viva

Environment and consent. Create privacy immediately — separate the accompanying partner for confidential history. Trauma-informed care: explain each step, allow a support person of her choosing, and emphasise that she may decline any or every element without losing medical care. Consent is ongoing and may be withdrawn.^[3]

Time-critical medical offers (within 72 hours).

1. Forensic examination by a trained sexual-assault examiner if she consents — highest yield within 72 hours; chain of custody; option to collect and hold without police report where lawful.^[1]
2. HIV nPEP if significant per-act risk: start ASAP, ideally within 24 hours and within 72 hours (not recommended beyond), 28-day three-drug regimen (bictegravir/emtricitabine/tenofovir alafenamide, or dolutegravir plus backbone) per the 2025 guideline, never delayed for laboratory results; follow up at 24 hours then 4–6 and 12 weeks.^[6]
3. STI prophylaxis (2021 CDC presumptive post-assault): ceftriaxone 500 mg IM single dose (1 g if 150 kg or more), doxycycline 100 mg twice daily and metronidazole 500 mg twice daily for 7 days; hepatitis B vaccine if non-immune (plus immunoglobulin only if the assailant is known HBsAg-positive).^[1]
4. Emergency contraception after pregnancy test: ulipristal 30 mg PO (to 120 h) or levonorgestrel 1.5 mg PO (best within 72 h); copper IUD most effective within 5 days if acceptable.^[2]

IPV and lethality. Screen alone with a validated tool (e.g. HARK). Ask specifically about non-fatal strangulation — over seven-fold odds of completed homicide — assess airway, neurology and neck vessels, and document carefully. Danger assessment + collaborative safety plan; bridge to sexual-assault and domestic-violence services. Competent adult: police report is her choice unless a statutory duty applies (child/vulnerable adult pathways differ).^[5][7]

Baseline tests. Pregnancy, HIV/HBV/HCV/syphilis; urine early if drug-facilitated assault suspected.^[1]