Blood-borne virus screening

Where there is a reasonable risk that the patient may have been exposed to blood-borne viruses, and PEP is being initiated, baseline blood tests should be taken in the ED for Hepatitis B, Hepatitis C and HIV.

Hepatitis B

If the perpetrator is not known, or not known to be Hepatitis B negative, accelerated Hepatitis B vaccination should be considered. This consists of one dose in the ED and two further doses with the General Practitioner or the sexual health clinic at 7 days and 21 days post-exposure.

Tetanus

Give Revaxis if there are tetanus-prone wounds and the patient is not fully immunised (5 doses, the most recent within 10 years).

HIV

Post-exposure prophylaxis after sexual exposure (PEPSE) can be effective in reducing transmission of HIV when initiated within 72 hours of exposure, however earlier administration is associated with improved efficacy.

PEPSE should be initiated in the ED and followed up by appropriate services such as a sexual health or GUM service.

Seroconversion can now be detected at 4 weeks post-exposure thanks to fourth generation HIV testing.

Learning bite

PEPSE should always be considered in the event of:

• Known HIV+ status of perpetrator
• Perpetrator has risk factors for HIV infection
• Anal rape
• Multiple assailants
• Bleeding post-assault/ rape.