title: Disparities in the provision of sexually transmitted disease and pregnancy testing and prophylaxis for sexually assaulted women in Rhode Island emergency departments.
abstract: OBJECTIVE
  To determine how often sexually assaulted adult female emergency department (ED) patients are being offered testing and prophylaxis for sexually transmitted diseases (STDs) and pregnancy and identify factors associated with the offering of tests and prophylaxis.
  
  
  METHODS
  This is a retrospective study of ED visits for adult female sexual assault in all Rhode Island EDs from January 1995 through June 2001. The percentage of patients offered testing and prophylaxis was calculated. Multivariable logistic regression was used to identify factors related to testing and prophylaxis use for women sustaining an anal/vaginal assault.
  
  
  RESULTS
  Of the 780 patients, 78.2% sustained anal/vaginal penetration, 5.0% genital touching only, and 3.7% oral sex only, and 13.1% did not know what happened to them. Of those women anal/vaginally assaulted, 83.8% were offered chlamydia/gonorrhea testing, 69.4% syphilis testing, 82.9% pregnancy testing, 77.0% chlamydia/gonorrhea prophylaxis, 47.6% emergency contraception, and 19.2% HIV prophylaxis. In multivariable logistic regression models, patients evaluated at the state's women's hospital instead of academic or community hospitals and those who sustained anal/vaginal assault instead of other assaults had a greater odds of being offered testing and prophylaxis. In some cases, older women were offered testing and prophylaxis less often than younger women.
  
  
  CONCLUSIONS
  Testing and prophylaxis for chlamydia/gonorrhea were used much more often than prophylaxis for emergency contraception and HIV, even for patients who were anal/vaginally assaulted. Disparities in testing and prophylaxis exist by type of hospital and, in some cases, by age. Educational campaigns should be instituted to ensure that all women receive adequate testing and prophylaxis commensurate with the exposure they sustained from a sexual assault.
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island 02903, USA. rmerchant@lifespan.org
authors.forename: Roland C
authors.initials: RC
authors.lastname: Merchant
authors.forename: Benjamin Z
authors.initials: BZ
authors.lastname: Phillips
authors.forename: Allison K
authors.initials: AK
authors.lastname: Delong
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards*; D019548:Crime Victims / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D011258:Pregnancy Tests / Q000379:methods / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000379:methods; D011785:Quality Assurance, Health Care; D011902:Rape / Q000175:diagnosis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000517:prevention & control*; D016387:Women's Health