Browse categories and answer follow-up questions to refine your symptom profile.
History
Context and timing
Assault context
Time since event
Location and environment
Number of assailants
Known vs unknown assailant
Threats or coercion
Physical restraint
Loss of consciousness
Amnesia or memory gaps
Intoxication at time of event
Exposure details for medical decisions
Exposure characterization
Contact types
Oral contact
Genital contact
Anal contact
Barrier use
Condom used throughout
Condom used partially
No barrier
Ejaculation exposure
Possible exposure
Uncertain
Post event actions
Showering or bathing
Douching
Changing clothes
Urinating
Brushing teeth
Eating or drinking
Symptoms and injuries
Current symptoms
Pain locations
Bleeding
Dysuria
Vaginal discharge
Rectal pain
Sore throat
Nausea or vomiting
Headache
Dizziness
Injury timeline
New bruising or abrasions
Neck pain
Chest wall pain
Abdominal pain
Back pain
Baseline reproductive and infectious risk
Reproductive history
Last menstrual period timing
Current pregnancy possibility
Current contraception
Breastfeeding status
Infectious history
HIV status if known
Hepatitis B vaccination status
HPV vaccination status
Prior STI history
Current genital symptoms pre existing
Patient goals and consent
Care preferences
Medical care only
Medical plus forensic exam
Police report now
Police report later
Anonymous or non report kit if available
Support person present
Interpreter needs
Photography consent if applicable
Alarm Features
Immediate safety and lethality risk
Immediate danger
Ongoing threat from assailant
Unsafe discharge destination
Stalking or access to patient
Weapons involved
Time critical medical red flags
Physiologic instability
Hypotension
Tachycardia out of proportion to distress
Hypoxia
Altered mental status
High risk injury patterns
Strangulation concern
Voice change
Dysphagia
Neck swelling
Neck bruising
Neurologic symptoms
Head injury concern
Loss of consciousness
Persistent vomiting
Severe headache
Focal deficits
Major bleeding
Heavy vaginal bleeding
Rectal bleeding
Hematemesis
Sexual violence specific escalation triggers
Urgent specialist involvement
Pediatric patient
Pregnancy with abdominal trauma
Severe genital pain preventing exam
Suspected retained foreign body
Suspected penetrating injury
Safeguarding and reporting triggers
Mandatory reporting considerations
Child abuse or vulnerable person
Immediate risk to others
Local protocol dependent pathways
Medications
Current and recent medications
Medication reconciliation
Prescription medications
Over the counter medications
Supplements and herbals
Recent antibiotics
Recent antiretrovirals
Medication related risks
High risk medication classes
Anticoagulants
Antiplatelets
Immunosuppressants
Sedatives and opioids
Antiseizure medications
Contraindications to prophylaxis
Key interaction checks
HIV PEP interactions
Emergency contraception interactions
Metronidazole alcohol use risk
Tetracycline pregnancy contraindication
Severe allergy history
Substance exposures
Substances around event
Alcohol
Cannabis
Stimulants
Sedatives
Opioids
Unknown substances
Diet
Recent intake and fasting
Intake pattern
Last oral intake time
Vomiting limiting intake
Poor oral intake since event
Hydration indicators
Hydration status
Thirst
Reduced urine output
Orthostasis symptoms
Alcohol exposure
Alcohol considerations
Recent alcohol use affecting consent recall
Alcohol use affecting metronidazole safety
Caffeine and energy drinks
Stimulant intake
High caffeine use
Palpitations or anxiety symptoms
Review of Systems
General
General symptoms
Fever
Chills
Weight loss
Fatigue
Cardiopulmonary
Cardiopulmonary symptoms
Chest pain
Dyspnea
Palpitations
Cough
Neurologic
Neurologic symptoms
Headache
Dizziness
Syncope
Weakness
Numbness
Vision changes
Head and neck
Head and neck symptoms
Sore throat
Hoarseness
Dysphagia
Neck pain
GI and GU
GI and GU symptoms
Abdominal pain
Nausea
Vomiting
Dysuria
Hematuria
Vaginal bleeding
Vaginal discharge
Pelvic pain
Rectal pain
Rectal bleeding
Skin and MSK
Skin and MSK symptoms
Bruising
Rash
Joint pain
Back pain
Collateral History and Family History
Collateral sources and supports
Collateral
Support person availability
Reliability of collateral report
Safety planning resources
Family history relevant to care
Family history
Bleeding disorders
Thrombophilia
Early cardiovascular disease
Social context and living situation
Social context
Housing stability
Dependent children
Caregiver availability
Language barriers
Prior trauma and mental health supports
Psychosocial background
Prior trauma history if volunteered
Existing therapist or counselor
Prior psychiatric diagnoses
Risk Factors
Infectious exposure risk
STI and bloodborne risk
Unknown assailant HIV status
Known assailant HIV positive
Known assailant hepatitis B positive
Multiple assailants
Mucosal injury suspected
Anal exposure
Pregnancy risk
Pregnancy risk factors
Reproductive potential
No reliable contraception
Assault timing within fertile window
Trauma and bleeding risk
Bleeding risk
Anticoagulant use
Bleeding disorder history
Heavy vaginal bleeding symptoms
Vulnerable populations
Special populations
Adolescent patient
Pregnancy
Postpartum
Immunocompromised
Elderly
Cognitive impairment
Legal and safeguarding risks
Safeguarding
Human trafficking indicators
Intimate partner violence
Coercive control patterns
Differential Diagnosis
Life threatening
Life threatening diagnoses
Strangulation related airway injury
Neck swelling
Voice change
Carotid or vertebral artery injury
Neurologic deficits
Severe headache
Intracranial hemorrhage
Loss of consciousness
Persistent vomiting
Internal bleeding
Hypotension
Abdominal tenderness
Sepsis
Fever
Rigors
Common
Common diagnoses
Acute stress reaction
Anxiety
Insomnia
Contusions and minor soft tissue injury
Bruising
Localized tenderness
Genital or anal mucosal trauma
Pain
Bleeding
Vaginitis or cervicitis
Discharge
Dysuria
Urinary tract infection (N39.0)
Dysuria
Frequency
Less common
Less common diagnoses
Pelvic inflammatory disease (N73.9)
Cervical motion tenderness
Fever
Pregnancy complication
Ectopic pregnancy (O00.9)
Threatened miscarriage (O20.0)
Substance related intoxication or poisoning
Somnolence
Amnesia
Mimics and pitfalls
Mimics and pitfalls
Pre existing vaginal bleeding causes
Fibroids
Hormonal contraception effects
Pre existing discharge causes
Bacterial vaginosis
Candidiasis
Non assault related bruising
Coagulopathy
Accidental trauma
Past Medical History
Medical and surgical history
Relevant conditions
HIV infection (B20)
Chronic hepatitis B (B18.1)
Chronic hepatitis C (B18.2)
Diabetes mellitus (E11.9)
Immunosuppression
Bleeding disorders
Prior surgeries and procedures
Gynecologic surgeries
IUD in place
Obstetric and gynecologic history
OB GYN history
Gravidity and parity
Prior ectopic pregnancy
Prior STI history
Mental health history
Mental health history
Depression (F32.9)
Anxiety disorder (F41.9)
PTSD (F43.10)
Prior self harm history
Baseline function and supports
Baseline status
Usual living situation
Usual supports
Usual substance use patterns
Physical Exam
Initial appearance and vitals
General and vitals
Appearance and distress
Level of consciousness
Vital sign pattern
Orthostasis if indicated
Head and neck
Head and neck exam
Scalp and facial injuries
Oral injuries
Neck tenderness
Neck bruising
Petechiae on face or conjunctiva
Voice quality
Stridor
Cardiopulmonary and abdominal
Trunk exam
Chest wall tenderness
Breath sounds
Abdominal tenderness
Guarding or rebound
Skin and MSK documentation
Injury survey
Bruise locations
Abrasion locations
Bite marks
Defensive injuries
Range of motion limitations
Genital and anal exam considerations
Anogenital exam principles
Patient consent for each step
Chaperone and examiner preference
Trauma informed pacing
Stop criteria with pain or distress
Exam components if consented
External inspection
Speculum exam indications
Bimanual exam indications
Anal inspection
Mental status and safety
Mental health screening
Acute distress
Dissociation
Safety at home
Suicidal thoughts screening per local protocol
Lab Studies
Pregnancy and baseline labs
Baseline labs
Urine pregnancy test
Serum beta hCG if equivocal
CBC if bleeding or trauma
CMP if starting HIV PEP
STI and bloodborne testing
Infectious testing
HIV antigen antibody test baseline
Syphilis serology baseline
Hepatitis B surface antigen baseline
Hepatitis C antibody baseline
NAAT gonorrhea and chlamydia
Trichomonas testing when indicated
Toxicology and substance concerns
Substance testing
Blood alcohol level if clinically indicated
Urine drug screen limitations
Forensic toxicology timing local protocol dependent
Interpretation and limitations
Test limitations
Early HIV testing window period
Early syphilis serology false negative
NAAT timing early after exposure
Urine drug screen false positives and negatives
Imaging
Scoring Systems
Imaging decision tools
Head injury decision rules when indicated
Canadian CT Head Rule local protocol dependent
PECARN for pediatrics local protocol dependent
Cervical spine decision rules when indicated
NEXUS criteria
Canadian C spine rule
MRI
MRI indications
Suspected spinal cord injury with neurologic deficit
Suspected ligamentous cervical spine injury with normal CT
Suspected soft tissue neck injury with persistent symptoms
CT
CT indications
CT head for concerning head injury
CT cervical spine for high risk neck trauma
CT angiography neck for strangulation with red flags
CT chest abdomen pelvis for major trauma pattern
Ultrasound
Ultrasound use
FAST exam for unstable trauma
Pelvic ultrasound for pregnancy complications
Soft tissue ultrasound for hematoma if needed
Special Tests
Medical forensic examination
Forensic evidence options
Sexual assault forensic kit availability local protocol dependent
Time window for evidence collection local protocol dependent
Separate consent for each component
Clothing collection procedures local protocol dependent
Specimen collection for STI
STI specimen collection
NAAT site selection based on exposure history
Self collection options if available
Wet mount if symptomatic local protocol dependent
Photography and documentation
Documentation adjuncts
Body map documentation local protocol dependent
Photo documentation consented and local protocol dependent
Chain of custody considerations local protocol dependent
Mental health screening tools
Screening tools
PTSD symptom screen local protocol dependent
Depression and anxiety screen local protocol dependent
ECG
Indications in this context
ECG indications
Chest pain
Palpitations
Syncope
Significant stimulant exposure
High risk findings
ECG red flags
Ischemic changes
QT prolongation
Ventricular arrhythmia
Serial ECG considerations
Serial ECG logic
Ongoing symptoms with initial nondiagnostic ECG
Electrolyte disturbance concern
Assessment
Problem list framing
Working problems
Sexual assault evaluation encounter (Z04.41)
Physical injury assessment
Pregnancy risk assessment
STI and HIV exposure risk assessment
Mental health and safety assessment
Severity and risk stratification
Risk stratification
High risk HIV exposure features
High risk pregnancy potential
High risk trauma features
High risk psychosocial safety concerns
Key supporting findings
Supporting data
Time since event relevance to evidence collection
Exposure history relevance to prophylaxis selection
Physical findings consistent with trauma
Baseline labs for medication safety
Plan
Trauma informed care and consent
Care approach
Private setting
Patient control over pacing
Consent for each step
Support person presence if desired
Interpreter use when needed
Forensic and reporting pathways
Forensic pathway
SANE or forensic examiner consult if available
Evidence collection window local protocol dependent
Law enforcement contact patient choice unless mandated
Infection prophylaxis and vaccines
Empiric STI prophylaxis adults and adolescents CDC guideline based
Ceftriaxone IM single dose
500 mg IM once
1000 mg IM once if weight 150 kg or more
Doxycycline
100 mg PO twice daily
Duration 7 days
Avoid in pregnancy
Metronidazole
500 mg PO twice daily
Duration 7 days
Avoid alcohol during and after per local protocol
Hepatitis B prevention
Hepatitis B vaccine if not immune
HBIG plus vaccine if assailant hepatitis B positive and patient not immune
HPV vaccine
Initiate or continue series per age and local protocol
HIV post exposure prophylaxis
HIV PEP decision making
Initiation as soon as possible
No later than 72 hours after exposure
Risk assessment based on exposure type and local prevalence
HIV PEP regimen examples local protocol dependent
Tenofovir DF emtricitabine daily plus dolutegravir daily
Tenofovir disoproxil fumarate 300 mg PO daily
Emtricitabine 200 mg PO daily
Dolutegravir 50 mg PO daily
Duration 28 days
Bictegravir tenofovir alafenamide emtricitabine single tablet daily
Use per local protocol and guideline availability
Duration 28 days
HIV PEP safety and monitoring
Baseline creatinine and liver enzymes
Medication interaction check
Antiemetic as needed
Pregnancy prevention
Emergency contraception
Levonorgestrel
1.5 mg PO once
Best as soon as possible
Ulipristal acetate
30 mg PO once
Avoid with immediate hormonal contraception restart per local protocol
Copper IUD
Within 5 days local protocol dependent
Consider if high efficacy desired and resources available
Symptom control and injury care
Analgesia
Acetaminophen 1000 mg PO once
Ibuprofen 400 mg PO once
Wound care
Clean and dress abrasions
Tetanus update per vaccination status
Reassessment loop
Reassessment timing
Repeat vitals after interventions
Pain reassessment
Anxiety and distress reassessment
Safety plan reassessment before discharge
Disposition
Level of care criteria
Admission or observation indications
Hemodynamic instability
Significant head injury concern
Strangulation red flags requiring monitoring or imaging
Severe uncontrolled pain
Unsafe discharge destination
Inability to complete basic self care due to distress
Discharge criteria
Discharge criteria
Stable vitals
No emergent injury requiring admission
Follow up plan arranged
Safe destination confirmed
Medications provided or prescriptions arranged
Follow up timing
Follow up plan
SANE clinic follow up local protocol dependent
Primary care follow up within 1 to 2 weeks
Repeat HIV testing schedule per guideline and local protocol
Repeat STI testing schedule per guideline and local protocol
Consults and referrals
Consultations
Sexual assault center advocate
Social work
Psychiatry if severe acute distress
Obstetrics gynecology if pregnancy or significant genital injury
Discharge Instructions
Copy discharge instructions
Patient instructions
You were seen today after a sexual assault
Your physical exam and tests today do not rule out all injuries or infections
Take the medications exactly as prescribed
If you started HIV prevention medicine take it every day for 28 days
Avoid alcohol if you were given metronidazole
Follow up for repeat testing as planned
Return to the emergency department now for any of the following
Trouble breathing
Fainting
Severe headache
New weakness or numbness
Neck swelling
Vomiting that will not stop
Heavy vaginal bleeding
Severe abdominal pain
Fever
If you feel unsafe at any time call emergency services or go to a safe place
You can access confidential support through local sexual assault services
References
Guidelines and protocols
Key references
CDC Sexually Transmitted Infections Treatment Guidelines 2021 section sexual assault and abuse adolescents and adults 2021
CDC HIV Nexus clinical guidance for post exposure prophylaxis updated page access 2025
CDC nPEP guidelines United States 2025
ACOG Committee Opinion Sexual Assault 2019
WHO Clinical management of rape and intimate partner violence survivors 2020
CMAJ Canadian guideline on HIV pre exposure and post exposure prophylaxis 2025
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.