Case Report:

A15-year-old girl was brought to the casualty unit because she had been raped last night. In casualty, she was examined and the appropriate police forms were completed. She now is brought to your
clinic for assistance in dealing with the threat of HIV infection.

She says that she does not know her assailant, and the police say it
is unlikely they will be able to find him.
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What are the immediate things that you should do?

If the assailant is apprehended and found to be HIV sero-negative, what should
you do?

Other than HIV protection, to what other conditions must you give attention?

If the victim is HIV sero-positive at the first testing, what should you do?.
COMMENT/ Explanation:


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COMMENT: This is an unfortunate case and it is doubly traumatic for the woman who now has been told of the threat of HIV infection. You always must be gentle and supportive. Request a baseline rapid HIV 110 test right away and if the test is negative, she must be started on post exposure prophylaxis (PEP) immediately. This regimen should be AZT and 3TC twice daily for 4 weeks. She also could take Nelfinavir if it is available.

She should be given emergency contraception to prevent pregnancy. She should be given a prescription for one dose ciprofloxacin 500mg and one dose of azithromycin 1g as a means of preventing or treating both gonorrhea and chlamydia. Doxicycline also can be used to prevent chlamydia.

A search must be made for the assailant and he should be tested for HIV. If he is HIV sero-negative, then the woman can stop taking her ARV prophylaxis. If he cannot be found and tested, she should continue her prophylaxis over the month. She should be reexamined for other sexually transmitted diseases or pregnancy within a month After 3 months, repeat her HIV test. If the result still is negative, she is probably is not infected, but needs one more test at 6 months to be certain. If the result is positive at either 3 or 6 months on two separate rapid HIV tests, she should be enrolled in an HIV program.

A polymerase chain reaction (PCR) test can detect the presence of the virus in the blood within one week of the assault, but this test is expensive. If her baseline HIV test is positive, then counsel her regarding her rape experience, and direct her to come for further testing and
counseling in the HIV clinic, at a time when she is more relaxed.

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