After sexual assault, the medical system has a specific protocol — HIV PEP, STI prophylaxis, emergency contraception, evidence collection. Here's what to expect.

Sexual Assault and STI Prophylaxis — What Happens at the ER

If you've experienced sexual assault, there's a specific medical protocol — STI prophylaxis, HIV PEP, emergency contraception, evidence collection if you choose. The system is designed to handle this without you having to explain everything. Most ERs have specialized SANE (Sexual Assault Nurse Examiner) programs.

This guide is for those who need information now — or for those supporting someone who does.

Resources for immediate support:

RAINN (Rape, Abuse & Incest National Network): 1-800-656-HOPE (4673) or chat at rainn.org
National Domestic Violence Hotline: 1-800-799-7233
The Trevor Project (LGBTQ+): 1-866-488-7386

The short answer

After sexual assault, the medical workup typically includes:

Need	Standard prophylaxis	Timing
HIV	PEP (28-day antiretroviral course)	Within 72 hours
Gonorrhea + chlamydia	Ceftriaxone + doxycycline OR azithromycin	At ER visit
Trichomoniasis	Metronidazole	At ER visit
Hepatitis B	HBIG + vaccine if not immune	Within 14 days
Pregnancy prevention	Plan B or Ella	Within 72-120 hours
STI follow-up testing	Window-period appropriate	2 weeks - 3 months
Mental health	Crisis support, referral	Same day + ongoing
Evidence collection	"Rape kit" if you want to preserve options	Up to 7-10 days
HSV / HPV	Not routinely prophylactic; testing offered later	Various

Going to the ER after assault

What to bring (if possible)

ID
Insurance (if available; not required)
The clothes you were wearing (if you can bring them — useful for evidence collection if you decide later)
A trusted friend or family member if possible

What you DON'T need to do

Don't shower, change clothes, or use the bathroom if you can avoid it — preserves evidence options
Don't feel pressure to report to police — separate decision from medical care
Don't have to identify the assailant
Don't have to make any decisions immediately

What happens at triage

You'll be brought to a private area quickly
A SANE nurse or trained provider will see you
Pace is set by you — you can pause anytime
Anyone you bring can stay or wait outside per your preference

The exam

Optional — you can decline any part
Sexual Assault Nurse Examiner does evidence collection if you want
Medical evaluation independent of evidence
Photo documentation of injuries if you consent
Standard physical exam

Time required

Often 3-6 hours total
More if evidence collection (rape kit)
Less if you decline some elements

STI prophylaxis offered

Bacterial STI prevention

Standard "antibiotic cocktail" given as single doses:

Ceftriaxone 500 mg IM (gonorrhea)
Doxycycline 100 mg twice daily for 7 days OR azithromycin 1 g single dose (chlamydia)
Metronidazole 2 g single dose (trichomoniasis)

This single intervention covers the most common bacterial STIs.

HIV PEP

If HIV exposure is possible:

28-day antiretroviral course
Started within 72 hours (ideally 24)
Standard regimen: Truvada + Dolutegravir
Follow-up HIV testing at 6 weeks and 3 months
Side effects usually mild
Free or low-cost in most states (Crime Victim Compensation often covers)

See PEP eligibility.

Hepatitis B prophylaxis

If not previously vaccinated: HBIG + hep B vaccine within 14 days
If vaccinated: usually nothing additional
Complete vaccine series if just starting

Hepatitis C

No effective prophylaxis exists
Test at appropriate windows (12 weeks, 6 months)
Cure with DAAs if infected (95%+ success) — see hep C cure

Pregnancy prevention

Plan B (levonorgestrel) within 72 hours — over-the-counter
Ella (ulipristal acetate) within 120 hours — prescription
IUD insertion within 5 days — most effective
Pregnancy test at follow-up if menses delayed

HSV

Not routinely given prophylactic antivirals
Testing offered if symptoms develop
Most HSV exposures don't result in transmission per single exposure
See herpes blood test accuracy

HPV

HPV vaccine not generally given as post-exposure
Discuss with provider if you're not vaccinated and within age range

Mpox

Vaccine if exposure possible and within 14 days
Especially for high-risk encounters

Evidence collection (the "rape kit")

Optional

You don't have to do this to get medical care
Separate from reporting to police
Many states preserve kits anonymously so you can decide to report later

What it involves

Photographs of injuries
Swabs of mouth, vagina, anus, body
Pubic hair combings
Fingernail scrapings
Saliva and DNA samples
Clothing collection

Timeline

Best within 72 hours
Some collection possible up to 7-10 days

What happens to the kit

Sealed and stored
Can be tested for DNA if you report
Can be kept untested until you decide

Mental health and crisis support

At the ER

Crisis counselor often available
Confidential
No pressure to talk about details

After the ER

Referrals to specialized counselors
Trauma-informed care
Support groups
Local rape crisis centers

Self-care

Sleep, eat, hydrate (basics)
Don't make major decisions immediately
Allow yourself feelings
Reach out to safe people

Legal and reporting considerations

Reporting to police

Separate from getting medical care
ER can help connect you to law enforcement IF you want
Statute of limitations varies by state
Can decide later in most cases

Title IX (campus assault)

Different process for students
Campus advocacy services
Can be pursued in addition to or instead of criminal report

Civil cases

Statute of limitations often longer
Can be pursued separately

What if you're past 72 hours?

HIV PEP no longer indicated (limited evidence past 72 hours)
HIV PrEP can still be started for ongoing risk
Hepatitis B prophylaxis still has window (up to 14 days)
Plan B / IUD windows for pregnancy may have passed (5 days)
STI testing still recommended
Mental health support still appropriate

What if you're past 7 days?

All immediate prophylaxis windows are past
STI testing at appropriate windows still essential
Pregnancy testing if missed period
Mental health support — always available
Reporting still possible (different legal windows)

Follow-up appointments

2-week visit

Re-test for chlamydia, gonorrhea, trich
HIV antibody/antigen test (early)
Pregnancy test
Check HBV status

4-6 week visit

HIV PEP completion check
HIV testing
Mental health check
Pregnancy status

3-month visit

HIV testing (confirmed clear)
Syphilis testing
Hep C testing
Mental health continuing

6-month visit

Hep C and B status
Long-term mental health
General gynecological/reproductive care

Special situations

Sex worker survivor

Same comprehensive care
Don't have to disclose work to ER
Trauma-informed providers can help
Specific sex-worker advocacy organizations exist

Male survivors

Same protocols apply
Less common but real
1in6.org for male survivors specifically
ER protocols accommodate male survivors

LGBTQ+ survivor

Affirming care available; advocate for yourself if needed
LGBTQ+ specific support: Trevor Project, FORGE Forward, Anti-Violence Project
Some ERs have LGBTQ+ trained SANE programs

Survivor with disability

Accommodations should be provided
Disability rights organizations can help
"End the Backlog" advocates for accessible care

Survivor who is undocumented

HIPAA protects medical records
ICE generally doesn't enter hospitals
Crime Victims Compensation may still apply
Sanctuary city services in some places

Common confusions

"If I take Plan B and don't get pregnant, I'm fine." Plan B only addresses pregnancy. STIs and HIV need separate evaluation.

"I can't get HIV from a single exposure." Single exposures can transmit HIV. PEP is recommended within 72 hours regardless of perceived probability.

"I have to report to police if I go to the ER." No. Medical care is separate. Mandatory reporting varies by state for some categories.

"Once I leave the ER, I'm on my own." No. Follow-up appointments are scheduled and crisis support is available 24/7.

"It's been too long; nothing matters now." Mental health support, STI testing, hepatitis B prophylaxis (up to 14 days), and many other interventions still apply.

Resources

Immediate crisis

RAINN: 1-800-656-HOPE (4673)
988 Suicide and Crisis Lifeline
Trevor Project (LGBTQ+): 1-866-488-7386

Long-term support

National Sexual Assault Hotline: 1-800-656-4673
Local rape crisis centers (search "rape crisis center [your city]")
Specialized trauma therapists
Online support communities

Legal advocacy

Local victims advocate (often at ER)
District Attorney victim advocacy programs
National Crime Victim Bar Association
Title IX coordinator (for students)

Bottom line

After sexual assault, the medical system has a protocol that includes:

STI prophylaxis (single antibiotic dose covers bacterial STIs)
HIV PEP (28-day course within 72 hours)
Hepatitis B prophylaxis (within 14 days)
Pregnancy prevention (Plan B / Ella / IUD)
Evidence collection (optional, "rape kit")
Mental health support (immediate + ongoing)
Follow-up appointments at 2 weeks, 4-6 weeks, 3 months, 6 months

You don't have to know the system. You just have to get to an ER. They handle the rest.

What happened is not your fault. Help is here. You're not alone.