Sexually transmitted infections among patients attending a sexual assault centre: a cohort study from Oslo, Norway.

OBJECTIVES: We estimate the prevalence of sexually transmitted infection (STI) among patients after sexual assault, assess the possible value of azithromycin prophylaxis, and identify risk factors for assault-related STI and for not presenting at follow-up. DESIGN: Prospective observational cohort study. SETTING: Sexual assault centre in Oslo, Norway. PARTICIPANTS: 645 patients, 602 (93.3%) women and 43 (6.7%) men, attending the centre from May 2017 to July 2019. OUTCOME MEASURES: Microbiological testing at the primary examination and at follow-up consultations after 2, 5 and 12 weeks. Estimated relative risk for assault-related STI and for not presenting at follow-up. RESULTS: At primary examination, the prevalence of genital chlamydia was 8.4%, Mycoplasma genitalium 6.4% and gonorrhoea 0.6%. In addition, the prevalence of bacterial STI diagnosed at follow-up and possibly from the assault was 3.0% in total: 2.5% for M. genitalium, 1.4% for genital chlamydia and 0.2% for gonorrhoea. This prevalence did not change when azithromycin was no longer recommended from January 2018. There were no new cases of hepatitis B, hepatitis C, HIV or syphilis. We found no specific risk factors for assault-related STI. Patients with previous contact with child welfare service less often presented to follow-up (relative risk (RR) 2.0 (95% CI 1.1 to 3.5)), as did patients with a history of sex work (RR 3.6 (1.2 to 11.0)) or substance abuse (RR 1.7 (1.1 to 2.7)). CONCLUSIONS: Most bacterial STIs were diagnosed at the primary examination, hence not influenced by prophylaxis. There was no increase in bacterial STI diagnosed at follow-up when azithromycin prophylaxis was not routinely recommended, supporting a strategy of starting treatment only when infection is diagnosed or when the patient is considered at high risk. Sex work, substance abuse and previous contact with child welfare services were associated with not presenting to follow-up. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03132389).

To be used or not to be used, that is the question: legal use of forensic and clinical information collected in a self-referral sexual assault centre.

This study explores how the police select cases for using information from a self-referral Sexual Assault Centre (SAC). The study is retrospective and descriptive: a 2-year series from a Scandinavian SAC and corresponding police files. The police had access to 163 SAC cases, requested 84% of available forensic medical documentation, and had 50% of the trace samples analyzed. The two main predictors of police utilization of forensic evidence were cases the police classified as rape and complaints filed during January to August. Extrinsic DNA was found in 27/60 trace evidence analyses, 21 matching a suspect. For one-third of the suspects who denied sexual acts, the forensic evidence contradicted their denial. Nonuse forfeited this possibility in several cases, and relevant information on injuries was lost. Our results indicate that available medical information is not fully utilized for legal purposes. Main barriers are police classification of cases and insufficient economic funding.

Sexual assault centres and police reporting--an important arena for medical/legal interaction.

This study explores the usefulness of forensic medical examination (FME) irrespective of police request and police-reporting practices at a self-referral Sexual Assault Centre (SAC). The study is retrospective, descriptive: a 2-year series of cases from a Scandinavian SAC and corresponding police files. Among 354 SAC cases, 180 were reported to the police, comprising 103 of 197 total rapes registered in this police district. Of 278 complainants presenting in time for FME, 55% reported to the police. FME was performed in 238 cases, 142 of these registered by the police. In 24% of the latter, examination preceded reporting by ≥ 2 days. Thus, substantial amounts of SAC casework remain unavailable to the police owing to nonreporting. However, performing FME regardless of reporting considerably increases the amount of information available to the police in late-reported cases. Although several factors predict reporting, the predictive power is insufficient for performing FME selectively.

Sexual assault centers: attendance rates, and differences between early and late presenting cases.

OBJECTIVE: Sexual assault centers (SACs) aim at assisting victims and to provide forensic medical examination (FME). This study explores the gap between assaults actually occurring and those seen at SAC; and the characteristics of cases presented in time/too late for FME (early and late cohorts). DESIGN: Retrograde descriptive study. SETTING AND SAMPLE: A two-year series from a self-referral SAC; characteristics of victims, assaults, use of services. METHODS: Chi-quadrate, uni- and multivariate logistic regression analyses. MAIN OUTCOME MEASURES: Number of female victims seen/female at-risk population (attendance rates). Case and service profiles in the two cohorts. Adjusted odds for late presentation. RESULTS: Attendance rates for females were 0.12% (14-55 years); an estimated 4-7% of sexually assaulted females in the catchment area. Two hundred and seventy eight victims arrived in time for FME, 76 later; 6% males. Assaults in the early cohort were more often performed by strangers. Two hundred and thirty-eight victims underwent FME, 55% complied with follow-up, 55% reported to the police. The late cohort contained more adolescent victims, more acquainted/partner perpetrators, more verbal coercion; 45% medically examined, 80% follow-up compliance; 34% reported to police. Further referrals occurred equally often in both cohorts; 12% to somatic and 39% to psychiatric services. Among victims seen, 5% died within 7 years of consultation. CONCLUSION: Cases seen at SAC are strongly selected. The late cohort seems more representative of the commonly occurring assaults; young victims, known assailants. Even late presenters are in need of a multidisciplinary approach.

Different Nordic facilities for victims of sexual assault: a comparative study.

BACKGROUND: Open multidisciplinary centers were operated in the mid 1990s for victims of sexual assaults in Oslo and Reykjavik. However, in Copenhagen and Helsinki forensic medical examination was only available to victims who reported directly to the police. One of the main aims of this study was to compare the effect of these different service facilities in four Nordic capitals on the victims' frequency to seek help and report sexual assaults to the police. METHODS: The age and attendance profile of 380 individuals, seeking support after sexual assault, was compared for the four capitals over a period of 1 year. The circumstances and consequences of assault, frequency and time lag of reporting were also compared. RESULTS: Open centers received several times more victims, especially in younger age groups, including more reported cases, when compared with the population at risk than forensic institutes. Victims were seen earlier for examination at forensic institutes that dealt with a more limited spectrum of sexual assaults than the open centers. The proportion of rape was higher amongst victims brought to forensic institutes whereas a higher proportion of victims received at open centers had been exposed to less violent assaults. The frequency of visits was higher at weekends, between 50% and 70% of victims reported consumption of alcohol, and one-third were attacked while sleeping. In the majority of cases only one perpetrator was involved, most often unknown or peripherally known to the victim. CONCLUSION: Open multidisciplinary centers receive and assist considerably more victims, reporting and not reporting sexual assaults than forensic institutes.