Monday, June 6, 2011

Medical Mondays: After an Attack

Today's Medical Monday's post is from a fellow blogger, writer, crit partner, medical-world colleague, and all around great gal: Laura Diamond.

*GRAPHIC CONTENT ALERT* In order to answer the questions well, I have to talk details. Sorry!

She asks, "My character is raped and injected with a drug. Would she need HIV prophylaxis afterwards?"

Boy, we really put our poor characters through so much. But to be realistic in fiction, we need to look at the facts.

After an unprotected sexual encounter, as well as injection drug use (both against the victim's will) we have to worry about several diseases.

Hepatitis C and B are both contracted through bloodborne means. Hepatitis C is more easily transmitted via needles than sex; Hep B is easy transmitted via both routes.

Postexposure Hep B/C treatment:
Unfortunately, none exists for Hep C. For Hep B, a vaccine would be given at the time of the evaluation, then one and six months later. They could also get prophylactic Heptatitis B immune globulin. The victim should be tested for both at the time of the evaluation, then a few weeks later. If positive for Hep C, they'd be referred to a specialist for possible treatment.

HIV (human immunodeficiency virus) can be contracted through bloodborne routes assuming several things--the person with HIV has a very high viral count, and the amount of blood transferred has enough virus in it. In the healthcare environment, the risk of contracting HIV from a needlestick exposure to an HIV infected patient is about 3/1000 without taking meds (CDC). So for this victim, worried about HIV and needle exposure, there would be a lot of questions that needed to be answered--how risky was the perpetrator? Was the drug injected like heroin, using a dirty needle, or a clean one?

Sexually, HIV can obviously be contracted, but certain types of sex are more high risk than others. For instance, the person on the receiving end is higher risk; also, anal receptive sex is much higher risk than vaginal because of the risk of tears and bleeding.

Postexposure HIV Treatment: A two or three antiviral drug regimen would be offered to the victim, to be taken for about a month. This is method is not set in stone; the medications can be difficult to take, and the risk of contracting HIV varies widely depending on the exposure, and the HIV risk factors of the perpetrator. The victim would need to be counseled heavily on the risks and benefits of taking the medications.

Other STDs: Sexually transmitted diseases, such as gonorrhea, chlamydia, syphilis and trichomonas are also a concern for rape victims.

Post-exposure STD treatment: Usually a cocktail is offered to the victim that includes treatment for all but syphilis, which can be tested for and treated later. The cocktail includes an intramuscular injection of an antibiotic (ceftriaxone), plus two other antibiotic pills taken for one day (azithromycin and metronidazole).

One last word--emergency contraception is usually offered as well during a post-rape evaluation and treatment, along with counseling and follow up appointments.

Hope this answers the questions, Laura!


Please keep in mind this post is for writing purposes only and is not to be construed as medical advice.

If you've got a fictional medical question, let me know! Post below or email me at
All I ask is that you become a follower and post a link on your blog when I post your answer.

45 comments:

DEZMOND said...

you're medical Mondays are always so informative and interesting, Lydia!

mooderino said...

terrific info as always. Cheers.

mood
Moody Writing
@mooderino

Laura Pauling said...

Thanks! Very interesting. :)

Old Kitty said...

Such an eye opener!! Wow. Take care
x

salarsenッ said...

This is a great question and definitely a reality. Your answer is very thorough. Thanks.

Anne Gallagher said...

Oh wow, that poor character. So much to think about.

Jennifer Shirk said...

Wow, very interesting as usual.

Sarah said...

Ug. That's a tough topic! Great info as always, though, Lydia.

Slamdunk said...

With the Q and A you do here Lydia, it is one of the best resources on the web--keep up the good work.

lbdiamond said...

Thanks, Lydia! Very helpful indeed. :)

Linda Gray said...

Wow, talk about insult to injury! How horrifying to have to go through all these difficult treatments after an event like that. It would be hard for most people not to see themselves as victims all over again. I guess that's where good counseling comes in!

Carol Kilgore said...

Excellent information, Lydia. Thank you so much.

Matthew MacNish said...

It's tough to consider all these details, but you must be commended for having the courage to be so informative.

Suze said...

I read 'GRAPHIC CONTENT ALERT' and knew I couldn't go further ...

**Sensitive gal.

Alex J. Cavanaugh said...

Thanks, and more than I ever needed to know!

notesfromnadir said...

I just finished reading a Stephen King short story where some of what you wrote about was mentioned. But the character wasn't injected w/ a drug.

Munk said...

Chlamydia rhymes with...

Lydia K said...

Don't you dare, MUNK!

Bossy Betty said...

Love Medical Mondays!

Stephanie Thornton said...

Wow- really informative! I love Medical Mondays!

Heather said...

Wow, now that is putting a character through the ringer! From what I know of the drug meant to prevent HIV it can also make the person taking it very sick. Is that true?

Heather said...

Wow, now that is putting a character through the ringer! From what I know of the drug meant to prevent HIV it can also make the person taking it very sick. Is that true?

Olga said...

Wow - I love your brief overviews of interesting medical things. After that, I feel the need to write a detective novel :)

Colene Murphy said...

YIPES! How scary! Good stuff to know though and be aware of!

Talli Roland said...

That's shudderific, but good to know if you have characters undergoing such things.

Kelly said...

Man, like the rape and attack isn't traumatic enough and then the victim has to do all this!
Very scary, informative post!!!

Steph said...

wow, great post! I have read storied where there was rape involved and none went into any detail of what the victim did after!

vbtremper said...

Wow, Laura, which WIP is that for? Nice job, Lydia. As always!

-Vicki

Sailor said...

Some detailed insider information. Very interesting!

itssacred said...

I love that you help out fellow writers by sharing your expertise! I think I may end up sending you a question soon.

Walt Mussell said...

That was educational. And graphic. Those are things that I never thought about.

Donna Hole said...

Thanks Lydia. That was indepth.

........dhole

Nas Dean said...

Interesting post, Lydia and so much information. Thanks for sharing.

Rachna Chhabria said...

Thanks Lydia....informative post as usual. Bit morbid, but we have to get realistic.

Chris Phillips said...

How very thorough.

Liza said...

It would be hard to read about a character going through all this...but this is where research is good. If you know what you need to know, it doesn't have to be included, but allows you to write from a basis in fact.

Jonene Ficklin said...

Very tastefully done - especially with the content you needed to cover. Thanks again for an interesting and informative Medical Monday!

-E- said...

that's some pretty crazy fiction there laura.

Michelle Teacress said...

I always admire your medical Monday posts. Thank you for the info. I've got a few more questions attached to the one in this post. Too bad we're not all sitting in the living room, chatting and eating snacks.

Medeia Sharif said...

Very informative. We do put your characters through some horrible things!

M Pax said...

I <3 your blog, Lydia. :D Thanks for so many great posts.

Theresa Milstein said...

This is one of the harder to read medical Mondays. Poor people that actually go through this, and then have to deal with pregnancy and disease.

Cassandra Frear said...

Ick!!

How's that for an honest reaction?

I guess all my characters will have to be in good health.

Meredith said...

That poor character! What an awful thing to go through.

Ciara said...

Oh, my. That's all I can say. I'm glad that there is more information about STD's now then when I worked in the hospitals. The drugs and testing has come a long way. Informative post.

 
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