Clinical Management of Survivors of Rape - A Guide to the Development of Protocols for Use in Refugee and Internally Displaced Person Situations (United Nations High Commissioner for Refugees (UNHCR) / Alto Comisionado de Naciones Unidas para los Refugiados (ACNUR) - WHO - OMS, 2001, 46 p.): Annex 5

Clinical Management of Survivors of Rape - A Guide to the Development of Protocols for Use in Refugee and Internally Displaced Person Situations (United Nations High Commissioner for Refugees (UNHCR) / Alto Comisionado de Naciones Unidas para los Refugiados (ACNUR) - WHO - OMS, 2001, 46 p.)

		(introduction...)
		Preface
		Acknowledgements
		Abbreviations and acronyms used in this guide
		Introduction
		STEP 1 - Making preparations to offer medical care to rape survivors
		STEP 2 - Preparing the survivor for the examination
		STEP 3 - Taking the history
		STEP 4 - Collecting forensic evidence
		STEP 5 - Performing the physical and genital examination
		STEP 6 - Prescribing treatments
		STEP 7 - Counselling the survivor
		STEP 8 - Follow-up care of the survivor
		Annex 1 · Information needed to develop a local protocol
		Annex 2 · Sample consent form
		Annex 3 · Sample history and examination form
		Annex 4 · Pictograms
		Annex 5 · Protocols for treatment of STIs
		Annex 6 · Protocols for post-exposure prophylaxis of HIV infection
		Annex 7 · Protocols for emergency contraception
		Annex 8 · Minimum care for rape survivors in low-resource settings
		Annex 9 · Additional resource materials

Annex 5 · Protocols for treatment of STIs

WHO-recommended treatments for adults

Note: These are examples of treatments for sexually transmitted infections. There may be other treatment options. Always follow local treatment protocols for sexually transmitted infections.

STI		Treatment
Gonorrhoea	azithromycin	2 g orally (not recommended in pregnancy) (Note: in this case you do not have to give further treatment for chlamydial infection)
		or
	ciprofloxacin	500 mg orally, single dose (contraindicated in pregnancy)
		or
	cefixime	400 mg orally, single dose
		or
	ceftriaxone	125 mg intramuscularly, single dose
Chlamydial infection	doxycycline	100 mg orally, twice daily for 7 days (contraindicated in pregnancy)
		or
	azithromycin	1 g orally, in a single dose (not recommended in pregnancy)
Chlamydial infection in pregnant woman	erythromycin	500 mg orally, 4 times daily for 7 days
		or
	amoxicillin	500 mg orally, 3 times daily for 7 days

Syphilis	benzathine	2.4 million IU, intramuscularly, once only
	benzylpenicillin	(give as two injections in separate sites.)
Syphilis, patient allergic to penicillin	doxycycline	100 mg orally twice daily for 15 days (contraindicated in pregnancy)
		or
	tetracycline	500 mg orally, 4 times daily for 15 days (contraindicated in pregnancy) (Note: both these antibiotics are also active against chlamydia)
Syphilis in pregnant women allergic to penicillin	erythromycin	500 mg orally, 4 times daily for 15 days (Note: this antibiotic is also active against chlamydia)
Trichomonas	metronidazole	2 g orally, in a single dose or as two divided doses at a 12-hour interval (contraindicated in the first trimester of pregnancy)

Give one easy to take, short treatment for each of the infections that are prevalent in your setting.

Example

Presumptive treatment for gonorrhoea, syphilis and chlamydial infection for a woman who is not pregnant and not allergic to penicillin

· azithromycin 2g orally + benzathine benzylpenicillin 2.4 million IU intramuscularly,
or
· ciprofloxacin 500 mg orally + benzathine benzylpenicillin 2.4 million IU intramuscularly + doxycycline 100 mg orally, twice daily for 7 days

If trichomoniasis is prevalent, add a single dose of 2 g of metronidazole orally.

WHO-recommended treatments for children and adolescents

Note: These are examples of treatments for sexually transmitted infections. There may be other treatment options. Always follow local treatment protocols for sexually transmitted infections and use drugs and dosages that are appropriate for children.

STI	Weight or age	Treatment
Gonorrhoea		ceftriaxone	125 mg intramuscularly, single dose
			or
	< 45 kg	spectinomycin	40 mg/kg of body weight, intramuscularly (up to a maximum of 2 g), single dose
			or (if > 6 months)
		cefixime	8mg/kg of body weight orally, single dose
	< 45 kg		Treat according to adult protocol
Chlamydial infection	< 45 kg	erythromycin	50 mg/kg of body weight daily, orally (up to a maximum of 2 g), divided into 4 doses, for 7 days
	³ 45 kg	erythromycin	500 mg orally, 4 times daily for 7 days
	but		or
	< 12 years	azithromycin	1 g orally, single dose
		doxycycline	100 mg orally, twice daily for 7 days
			or
	³ 12 years	azithromycin	1 g orally, single dose
			or
		erythromycin	500 mg orally, 4 times daily for 7 days
Syphilis		benzathine penicillin	50 000 IU/kg IM (up to a maximum of 2.4 million IU), single dose
Syphilis, patient allergic to penicillin		Erythromycin or doxycycline in the dosages recommended for chlamydial infection for 14 days
Trichomoniasis	< 12 years	metronidazole	5 mg/kg of body weight orally, 3 times daily for 7 days
	³ 12 years		Treat according to adult protocol

Based on: Tailoring clinical management practices to meet the special needs of adolescents: sexually transmitted infections. Geneva, World Health Organization (document WHO/CAH 2002, WHO/HIV/AIDS 2002.03), in print.