replaced vaginal/cervical/urethral culture in both prepubertal and pubertal female and male patients In addition, while NAATs are not FDA-approved for extragenital sites, the extensive use and reliability of this technology has resulted in reliable use on pharyngeal, urine, and rectal specimens for GC and CT While culture may be used, compared to NAATs, it is an inferior testing method for chlamydia detection If NAAT is performed, all positive tests should be confirmed by a second NAAT that targets a different genomic sequence to increase specificity of the test; most commercial test kits include a second DNA probe for this purpose Cervical specimens are not recommended for prepubertal females All vesicular or ulcerative genital or perianal lesions should be sent for PCR and/or viral culture to test for genital herpes The preferred testing method for Trichomonas vaginalis is NAAT, given the poor sensitivity and specificity of wet mount Syphilis testing should be performed using rapid plasma reagin (RPR) test, and Hepatitis B testing is indicated if the patient has not been fully immunized against this infection Hepatitis C has been associated with intravenous drug abuse and should be considered as part of the STI testing when there is a perpetrator history of drug use HIV serum testing should be performed using a fourthgeneration p-24 antigen/HIV-1 and HIV-2 antibody combination (preferred) or a third-generation HIV-1/2 antibody immunoassay HIV testing should be performed after appropriate counseling, emphasizing that the test result will only provide evidence of infection acquired prior to months, although the new fourth-generation HIV immunoassays can detect more acute HIV-1 infection Postexposure Prophylaxis The risk of a child acquiring an STI as a result of sexual assault/abuse has not been well studied In prepubertal patients, prophylaxis is not recommended because the incidence of infection is low after assault/abuse as is the risk for ascending infection, and regular follow-up of children can usually be ensured In contrast, all pubertal patients should be offered STI prophylaxis due to higher pretest probability of having an STI, and poor follow-up rates among this patient population Empiric antibiotics for GC, CT, and TV are given See Table 127.5 for recommended treatments and doses It is recommended to refer to the CDC STD treatment guidelines for those requiring alternative regimens Patients who have not been previously vaccinated against Hepatitis B should receive the Hepatitis B vaccination, without Hepatitis B immunoglobulin (HBIG) If the assailant is known to be HBsAg-positive, victims should be given both Hepatitis B vaccine and HBIG with follow-up vaccine doses at to months and to months after the first dose Finally, consider Hepatitis C testing based on risk assessment of assault HPV vaccination is also recommended for male victims to 21 years of age and female victims aged to 21 who were unvaccinated prior to the acute sexual assault Follow-up HPV vaccination dosing is recommended at to months and months after the first dose HPV vaccination reduces risk of infection with human papillomavirus Remember, the HPV vaccination is contraindicated in pregnant women and in those with an allergy to yeast A negative HCG should be obtained prior to administering this vaccination HIV Prophylaxis HIV prophylaxis is not universally recommended because although HIV seroconversion has occurred in people whose only risk factor was sexual assault, the frequency of this occurrence is extremely low Several factors impact the medical recommendation for HIV postexposure prophylaxis (PEP) These include the likelihood of the assailant having HIV; any exposure characteristics that might increase the risk for HIV transmission based on type of sexual contact (e.g., single episode vs multiple/chronic), time elapsed after the event, and the potential benefits and risks associated with PEP Most often, an assailant’s HIV status at the time of the assault examination is unknown It is therefore important to consider any known HIV-risk behaviors of the perpetrator, local epidemiology of HIV/AIDS, and exposure characteristics of the assault Higher-risk exposures include vaginal or anal receptive intercourse, forceful intercourse, ejaculation on any mucous membrane, history of multiple assailants, and whether mucosal lesions are present in the assailant or patient TABLE 127.5 SEXUAL ASSAULT PROPHYLAXIS BY WEIGHT GROUP a For prevention of Weight