Integrated clinical service for sexual assault victims in a genitourinary setting

Background: Reported sexual assault is increasing, and the diverse immediat e and longer term needs of the victim are usually met by exposure to a numb er of healthcare professionals often in different locations, involving dela ys and travel, increasing the trauma for the victim. Objectives: To set up a centre to address the immediate and longer term nee ds of the sexual assault victim and review issues arising during the develo pment of the service. Methods: Description of setting up the service in the genitourinary medicin e department of Kings College Hospital, south London, and the aspects of ca re offered. Results: The number of victims referred by police increased from 15 in 1992 to 58 in 1996. In 1996, 55 female and three male victims were seen. 23 dif ferent police stations brought victims for examination; mean age of the vic tim was 27 years (range 14-60), median time between assault and examination was 22 hours (range 3 hours-3 months); 23% had genital injuries, 59% had o ther physical injury, and 11% needed further hospital care. 71% accepted sc reening for sexually transmitted infection (STI), 21% had an STI diagnosed, 16% of the women required emergency contraception, 26% received prophylact ic antibiotics, and 58% saw a health adviser. 70% had a follow up appointme nt arranged of which 50% attended. Conclusion: The high uptake of STI screening, emergency contraception, heal th adviser consultation, and follow up supports the concept of a comprehens ive integrated system to meet the disparate needs of the victim while still obtaining the necessary forensic evidence. The wide catchment area of serv ice users indicates gaps in services available for the assault victim. Earl ier genitourinary involvement after sexual assault is becoming increasingly pertinent in relation to HIV prophylaxis.