Examination of the patient with a Wood light may help identify semen, which will ﬂuoresce blue-green to orange. Areas of ﬂuorescence should be swabbed with a cotton-tipped applicator moistened with sterile water, then air dried and submitted as evidence. Swabs of the skin, vagina, mouth, breasts, and rectum may be obtained to test for the presence of sperm or semen. In general, use a dry swab to obtain evidence from wet areas, and a wet swab to obtain evidence from dry areas.
2.
A Pap test may be useful to document the presence of sperm.
3.
A sample of the vaginal secretions should be obtained for examination for motile sperm, semen, or pathogens. Motile sperm in the vagina indicate ejaculation occurred within 6 hours. Nonmotile sperm can be found in the cervical mucus for as long as 1 week after ejaculation. If ejaculation occurred in the mouth, seminal ﬂuid may be rapidly destroyed by salivary enzymes (142). If the survivor reports an anal assault, specimens can be obtained by washing the rectal vault with 10 mL of normal saline injected with a red rubber catheter. Allow the saline to stand for several minutes, then aspirate the rectal ﬂuid and submit as evidence.
4.
Vaginal secretions should be collected for DNA fingerprinting and to test for the presence of seminal contents, including acid phosphatase, p30 protein (specific to the prostate), seminal vesicle-specific antigen, and ABO antigens (151).
5.
The survivor’s pubic hair should be combed over a sheet of paper in an attempt to obtain pubic hair from the assailant. Both the comb and the pubic hair should be submitted as evidence. If the pubic hair is matted, it should be clipped, not pulled, and submitted.
6.
Fingernail scrapings from the survivor should be collected using an orangestick and evaluated for evidence of trace fibers or the assailant’s blood, hair, or skin. Use a wet swab to obtain evidence for DNA fingerprinting from between the survivor’s fingers.
7.
Saliva should be collected from the survivor to document whether she is a secretor of major blood group antigens (80% of the population are secretors). If the patient is not a secretor and blood group antigens are found in vaginal washings, the antigens are probably from the semen of the assailant (151).
8.
Respiratory spray from where the assailant placed his face and breathed on the survivor may be collected from her breasts, shoulders, face, or neck. Collect the sample with a moist swab and submit for DNA analysis.
Treatment Treatment of sexual assault survivors should be directed to prevention of possible pregnancy and provision of prophylactic treatment for STDs (Table 11.8). About 5% of fertile rape survivors become pregnant as a result of the rape. All sexual assault survivors of reproductive age should be offered emergency contraception (157). If the survivor desires emergency contraception, a preexisting pregnancy can usually be ruled out by performing a sensitive human chorionic gonadotropin assay. Pregnancy prophylaxis can be provided by several different regimens (158–160).
1.
Administration of one tablet containing 0.75 mg of levonorgestrel followed by a second tablet 12 hours later (Plan B). A single 1.5-mg dose of levonorgestrel is just as effective as the two-dose regimen and is the preferred method of emergency contraception (159). Levonorgestrel is available by prescription for women younger than 17 years, and available over the counter for women 17 years and older. Levonorgestrel is more effective than any other emergency contraception method and has the fewest side effects (160) 2.