ED Pathway for Evaluation/Treatment of Children with Sexual Abuse Concerns

STI Prophylaxis

Treatment is indicated in the following patients who have been tested for STIs

All post-pubertal patients
Pre-pubertal patients

Treatment for Post-pubertal Patients, Pre-pubertal Patients ≥ 45 kg

To treat for GC, Chlamydia, Trichomonas and BV, give one dose each of the following:

Ceftriaxone 250 mg IM or IV
Azithromycin 1g po
Metronidazole 2g po or Metronidazole 2g IV

Treatment for Pre-pubertal Patients < 45 kg

Ceftriaxone 125 mg IM once or IV
Azithromycin 20 mg/kg po once (maximum is 1000 mg)
Metronidazole 15 mg/kg po divided TID 7 days

Anti-Emetic

See CDC Guidelines for special scenarios

Treatment for Patients not immunized for Hepatitis B

First dose of Hepatitis B vaccine to be given in ED
If perpetrator is known to be HBsAg positive, HBIG should also be given