Sexually transmitted infection screening and prophylaxis, including HIV, should be provided as per protocol. For those starting HIV post-exposure prophylaxis, medications/prescriptions should be provided and the patient linked to outpatient services. 

The SANE nurse should be consulted for forensic medical examination.¹⁶ The steps and processes are essentially the same for the male patient except for the genital examination. Swabs of the male genitalia should be obtained, paying attention to the penile glans/prepuce, shaft, base, and anterior scrotum. Two moistened swabs are used, but more can be used on each specific outlined area. Male victims may experience anal penetration at a higher rate than female victims, so an anorectal examination should be performed. Swabs should be obtained from the perineum, perianal area, and anal canal.¹⁷ Anoscopy can be performed to look for injuries to more internal structures.¹⁸ Some SANE nurse programs use anoscopy within their scope of practice. Significant anal or rectal trauma may require evaluation by general, trauma, or colorectal surgery. 

Case Resolution

The patient was seen by the emergency physician. No serious injuries were identified during the medical screening examination. Sexually transmitted infection and HIV prophylaxis were initiated. The on-call rape crisis advocate and SANE were called in and law enforcement notified. The SANE nurse collected evidence and turned it over to the police. The SANE nurse found swelling and redness of the anal fold and a small tear. It was determined with the emergency physician that no specific treatment was required and the patient was discharged with all the standard sexual assault referrals. 

Dr. Rozzi is an emergency physician; director of the Forensic Examiner Team at WellSpan York Hospital in York, Pennsylvania; and past-chair of the Forensic Section of ACEP.

Dr. Riviello is chair and professor of emergency medicine at the University of Texas Health Science Center at San Antonio.

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