Rape Crisis Syndrome

BASICS

Synonyms: Rape trauma syndrome; post-sexual assault trauma
Definition: Trauma following sexual assault; includes acute and long-term psychological, physical, and behavioral responses
Modern terminology: Now described as acute stress reaction (ASR, <3 days), acute stress disorder (ASD, 3 days–1 month), or posttraumatic stress disorder (PTSD, >1 month)
Applies to: All sexual and gender identities

History of sexual or other violence, psychological aggression, physical violence, or stalking
Early initiation of sexual activity
High-risk sexual behavior
Exposure to familial/environmental violence
Substance use (alcohol, illicit drugs)
Traditional gender role beliefs

Primary: Promote gender equality, teach prevention skills, empower and support at-risk populations, create protective environments
Secondary: HARK screening tool (Humiliation, Afraid, Raped, Kicked): 81% sensitivity, 95% specificity for intimate partner violence

Use trauma-informed care: realize, recognize, respond, and resist retraumatization
Avoid blame-implying or investigative questioning
Assess for patient safety
Use patient’s own words; clarify unclear terms
Document all trauma (type, attempted/actual, force used), alcohol/drug use, events that may alter forensic evidence (bathing, changing clothes, etc.)
Obtain full gynecologic history, history of strangulation (consider neck imaging if positive)

Preferably performed by trained Sexual Assault Nurse Examiners (SANEs)
Document all signs of trauma, mental/emotional state
For strangulation: assess scalp, eyes, ears, neck, chest, neuro/respiratory/voice/throat status
Obtain consent before each step
Optional: secure medical photos, Wood lamp/forensic goggles for biological specimen detection
SAFE Kit (rape kit): swabs from oropharyngeal, anogenital, and other sites as needed

Enhanced sensitivity/privacy; trauma-informed approach
Mandatory reporting to law enforcement
Engage support agencies (rape crisis centers, victim advocates, SART/SANE, social work)
Assess and treat psychological sequelae; behavioral health referral

STI prophylaxis/treatment (empiric):
Gonorrhea: Ceftriaxone (adult: 500 mg IM <150kg; 1 g IM ≥150kg; peds: 25–50 mg/kg)
Chlamydia: Azithromycin 1 g PO x1 or doxycycline 100 mg PO BID x7d; pediatric alternatives as appropriate
Trichomoniasis: Men: metronidazole/tinidazole 2 g PO x1; Women: metronidazole 500 mg PO BID x7d
Bacterial vaginosis: Metronidazole 500 mg PO BID x7d or topical agents
Hepatitis B: HBIG 0.06 mL/kg IM x1 + 3-dose vaccine series (if not immune)
HPV: Vaccine for ages 9–26 (may consider 27–45)
Syphilis: Benzathine penicillin G 2.4M U IM x1 (if high risk)
HIV post-exposure prophylaxis: TDF/emtricitabine + raltegravir/dolutegravir x28 days (initiate <72h; consult ID for children)
Emergency contraception: Plan B, ulipristal, or copper IUD (if pregnancy risk)

1–2 weeks: Counseling, repeat pregnancy/gonorrhea/chlamydia testing, vaginitis check
6, 12, 24 weeks: Syphilis/HIV testing
4–8 weeks: HPV/genital wart assessment

Be aware: sexual assault victims (especially younger females) may have increased rates of disordered eating

Always use a trauma-informed care approach; avoid retraumatization
All cases must be reported to appropriate authorities
SANE/SART teams, enhanced privacy/sensitivity, and rapid access to behavioral health are key to optimal care