Followup care

Encourage followup STI exams, testing, immunizations, counseling, and treatment as directed.[1] Although patients may be reluctant to go for followup exams for STIs, such exams are essential because they provide an opportunity to detect new infections acquired during or after the assault, complete hepatitis B immunization, if indicated, and complete counseling and treatment for other STIs. Examinations for STIs for all patients should be repeated according to exam facility policy—the CDC recommends a followup appointment within 1 to 2 weeks of the assault. If patients tested negative at the time of the medical forensic exam and chose not to receive prophylaxis, followup testing should be conducted.[2] The CDC recommends that in this case the followup exam be done within a week to ensure that positive test results are discussed promptly with patients and treatment is offered. The CDC recommends followup testing for patients who received treatment only if they report having symptoms consistent with an STI. (However, patients who were treated should be informed of the option of followup testing to confirm the presence or lack of infection.) The CDC recommends that testing for syphilis and HIV infection should be repeated 6, 12, and 24 weeks after the assault if initial test results were negative and if these infections are likely to be present in assailants (see the upcoming section on evaluating risk for exposure to HIV).

It is important that followup communication with patients (particularly by examiners and advocates) include a reminder to go to followup exams and receive STI-related testing, immunizations, and treatment as directed. Advocates and health care personnel may be able to assist patients in making followup appointments, obtaining transportation to and from appointments, and determining how to pay for expenses involved with followup testing and care. Some jurisdictions may cover followup treatment as part of initial care through funds such as crime victims’ compensation. In such instances, patients may be more apt to seek followup treatment. Advocates may also be able to accompany patients to these followup appointments.


[1] This paragraph is drawn from Sexually Transmitted Diseases Treatment Guidelines, 2002, p. 70.
[2] Infectious agents acquired through the assault may not have produced sufficient concentrations of organisms to result in positive test results at the medical forensic exam. (Sexually Transmitted Diseases Treatment Guidelines, 2002, p. 70.)


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