Launceston General Hospital Clinical Guideline SDMS ID P2010/0935-001 WACSClinProc9.

3/10 Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Emergency Contraception and Chlamydia Prophylaxis following Sexual Assault New guideline Emergency contraception and Chlamydia prophylaxis following sexual assault Sexual assault forensic nurse examiners, medical officers Emergency contraception, chlamydia prophylaxis, sexual assault, sexual assault forensic nurse examiner Sexual Assault Forensic Examination WACSClinProc9.2/09 Medication Administration and Management for Nurses: LGH Policy 21-10

Emergency Contraception Emergency contraception should be considered in all cases of female sexual assault where conception and unwanted pregnancy may be a possibility. To enable women to make an informed choice, a comprehensive explanation must be provided with adequate time allowed for this. A written information sheet will also be provided (Attachment 1). Assessment to be undertaken prior to the administration of emergency contraception includes: Date of last menstrual period History of unprotected intercourse and possibility of existing pregnancy Current medications Allergy Medication Levonorgestrel (Prostinor-2) 1.5 mg stat should be taken as soon as possible after unprotected intercourse and is most effective if taken within 72 hours after unprotected intercourse but can be used up to 120 hours after unprotected intercourse. Contraindications Proven pregnancy or suspected pregnancy (maybe given if BHCG is negative) Emergency contraception can be given if the victim is possibly pregnant from a time previous to the assault. Interactions Hepatic enzyme inducing medication: rifampicin, griseofulvin, phenytoin, carbamazepine, primidone, St Johns Wart, barbiturates, rifabutin, ritonavir. These may lessen the effectiveness of Levonorgestrel.

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Common side effects Nausea, vomiting, dizziness, fatigue, headache, breast tenderness, lower abdominal pain Education Written information provided Advise woman that if vomiting occurs within 3 hours of emergency contraception they need to return for a repeat dose Women should see their doctor or the Sexual Health Service for a pregnancy test in 3 weeks if Late period (> 7 days late) High risk of pregnancy Chlamydia Prophylaxis Prophylaxis for STIs after sexual assault is not generally indicated. Victims of sexual assault may be offered prophylactic treatment for Chlamydia trachomatis. Chlamydia trachomatis infection is the most common notifiable sexually transmitted bacterial infection worldwide. Prophylactic treatment for Chlamydia trachomatis is likely to be effective. All clients will be referred to Sexual Health Service or their general practitioner for assessment and treatment of other sexually transmitted infections. Medication Azithromycin 1g (macrolide antibiotic) orally as a single dose stat Doxycycline or erythromycin may be used if allergy to Azithromycin exists. Contraindications Allergy to Azithromycin or any other macrolide or ketolide antibiotics (eg clarithromcyin, erythromycin, roxithromycin, telithromycin Interactions Ergot derivatives, cyclosporine, digoxin, antacids, terfenadine, coumarins Side effects GI upset Sexual Assault Forensic Nurses Examiner Nurse Administration of Medications Emergency contraception and Chlamydia prophylaxis packs are stored in the locked medication drawer in SAFE examination room for use by the sexual assault forensic nurse examiners. All medications must be ordered by a medical officer on the medication chart. Alternatively, a telephone order from a medical officer may be obtained (as per Medication Administration and Management for Nurses: LGH Policy 21-10) Levonorgestrel 1.5mg (Postinor-2) orally stat Azithromycin 1g orally stat for emergency contraception for Chlamydia prophylaxis

These doses may be repeated once if the client returns reporting vomiting or diarrhoea within 3 hours of administration of the medication.

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All Staff Positions accountable for a) compliance with the policy: medical officers and sexual assault forensic nurse examiners b) monitoring and evaluation of the policy: LGH sexual assault service c) development and revision of the policy: LGH sexual assault service Attachments
Attachment 1 Emergency Contraception Information Sheet

References: Royal Australian and New Zealand College of Obstetricians and Gynaecologist 2004, Medical responses to adults who have experienced sexual assault: an interactive educational module for doctors, RANZCOG Melbourne Sexual Health Centre 2007, Emergency Contraception Fact Sheet, Online: http://www.mshc.org.au/FactSheets/tabid/253/Default.aspx Melbourne Sexual Health Centre 2008, Clinical Practice Guideline: Clinical Management of Emergency Contraception, Online: http://www.mshc.org.au/ManagementGuidelines/NursePractitionerClinicalPracticeGui delines/tabid/412/Default.aspx New South Wales Department of Health 2005, Sexual Assault Services Policy and Procedure Manual (Adult) Online: http://www.health.nsw.gov.au/policies/pd/2005/PD2005_607.html Performance Indicators: Emergency contraception and Chlamydia prophylaxis will be provided in a timely manner to all clients who present to the sexual assault service at the LGH. Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years by the LGH Sexual Assault Service. Developed By: Medical officers and sexual assault forensic nurse examiners, LGH Sexual Assault Service Medical officers and sexual assault forensic nurse examiners, LGH Sexual Assault Service

Stakeholders:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: _________________________

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ATTACHMENT 1: Emergency Contraception Information

What is emergency contraception? Emergency contraception is an extremely effective and safe way of preventing pregnancy. It reduces the risk of pregnancy to 1-2%. Emergency contraception should be taken as soon as possible after the assault and is most effective if taken within 72 hours. How do I take it? Take two Postinor-2 (750mg) tablets as a single dose. How does it work? Emergency contraception works by preventing or delaying the release of the egg in the first half of the cycle or preventing the implanting of the fertilised egg in the second half of the cycle. Some side effects you may experience? You may get breast tenderness, headache and light bleeding in the couple of days following the emergency contraceptive pills, but these symptoms will usually disappear after 48 hours and require no treatment. The light bleeding some women have is not a normal period. Periods after the emergency contraceptive pill Your period could be early, late or on time after taking the emergency contraceptive pill, but most women will have a period within three to four weeks of taking it. The emergency contraceptive pill is not 100% reliable. If you have not had your periods with four weeks you should see you doctor or the Sexual Health Service to have a pregnancy test done. If pregnancy occurs There is a very small risk that a pregnancy occurring after the emergency contraceptive pill could happen in one of your tubes instead of your womb. This means that a pregnancy test is very important if there is any suspicion of pregnancy. Sexual Health Services Provide confidential sexual health service with no cost for the client. Sexually transmitted infection testing, information and antibiotic treatment, when required, is also provided free of charge. The Sexual Health Service is located at: 42 Canning Street LAUNCESTON TAS 7250 P 6336 2216

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