ffAdvise not to throw out or change clothing, wash, shower, douche, brush their teeth or use mouthwash; doing so may destroy evidence}<b>ffInitial assessment (history and examination) – use standard forms if available</b><br>–– Type of injuries sustained (particularly to the mouth, breasts, vagina and rectum) –– Any bleeding from or abrasions on the patient or assailant (to help assess the risk of transmission of HIV and hepatitis) –– Description of the attack (e.g., the orifices which were penetrated, whether ejaculation occurred, or whether a condom was used) –– Assailant’s use of aggression, threats, weapons and violent behavior –– Description of the assailant –– Use of contraceptives (to assess risk of pregnancy), previous coitus (to assess validity of sperm testing) –– Clearly describe size, extent, nature of any injury. If possible take photos of the lesions (with patient’s consent)}<b>ffTest for HIV, RPR, hepatitis B and pregnancy, to assess baseline status of the patient</b><br>If possible test for flunitrazepam and gamma hydroxybutyrate (”rape drugs”)}<b>ffCollect forensic evidence (with standard kits if available)</b><br>–– Condition of clothing (e.g., damaged, stained, adhering foreign material) –– Small samples of clothing including an unstained sample, given to the police or laboratory –– Hair samples, including loose hairs adhering to the patient or clothing, semen-encrusted pubic hair, and clipped scalp and pubic hairs of the patient (at least 10 of each for comparison) –– Semen taken from the cervix, vagina, rectum, mouth and thighs –– Blood taken from the patient –– Dried samples of the assailant’s blood taken from the patient’s body and clothing –– Urine, saliva –– Smears of buccal mucosa –– Fingernail clippings and scrapings –– Other specimen as indicated by the history or physical examination}<b>ffProphylaxis for STD including:</b><br>–– Ceftriaxone 125 mg IM or cefixime 400 mg orally stat –– Azithromycin 1 g stat or doxycycline 100 mg twice a day for 1 week –– Metronidazole 2 g stat –– HIV Post Exposure Prophylaxis if within 72 hours: Adults : TDF+3TC+ATV/r for 28 days Children: ABC+3TC+LPV/r}ffHepatitis B vaccine if not already immunised}ffEmergency contraception if within 72 hours (but may be useful up to 5 days after)}Levonorgestrel 1.5 mg (double the dose if patient is HIV positive on ARVs)}<b>ffCounselling:</b><br>use common sense measures (e.g., reassurance, general support, non-judgmental attitude) to relieve strong emotions of guilt or anxiety ffProvide links and referral to: –– Long term psycho-social support –– Legal counseling –– Police- investigations, restraining orders –– Child protection services –– Economic empowerment, emergency shelters –– Long-term case management