Welch and Mason listed indications for when to provide prophylaxis to HIV following rape or other form of sexual assault. The authors are from King's College Hospital in London.


No prophylaxis is recommended if any of the following is present:

(1) 72 or more hours (3 days) have passed since the exposure

(2) a condom was worn and the victim was not exposed to the attacker's body fluids

(3) the attacker is known to be HIV negative

(4) there are no factors associated with high risk of transmission


Definite indication for prophylaxis:

(1) attacker known to be HIV positive

(2) attacker has risk factors for HIV AND one or more risk factors for transmission present


Prophylaxis should be given based on the patient's request:

(1) not one of the other choices (attacker does not have risk factors for HIV infection AND one or more risk factors for transmission are present)


Factors associated with a high risk of transmission:

(1) defloration

(2) anal intercourse

(3) biting by the attacker

(4) biting by the victim

(5) multiple assailants (gang rape)

(6) multiple episodes of penetrations

(7) other forms of trauma at the site of penetration

(8) current sexually transmitted disease

(9) oral intercourse

(10) contact any body fluid from the attacker to the victim's mouth, nose, eyes, mucous membrane or broken skin


Risk factors for HIV in the assailant (if HIV status not known)

(1) injecting drug user

(2) attacker from a high prevalence area or group

(3) male who has sex with men


The victim and the assailant(s) should be monitored for evidence of HIV disease.


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