Question 8 - Sexual Assault and Abuse and STIs Question Bank

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Sexual Assault and Abuse and STIsQuestion 8/10

A 21-year-old woman is evaluated in the emergency room after reporting she was sexually assaulted by a single male assailant. The male assailant is arrested and agrees to laboratory testing. The woman who suffered the sexual assault has never received the hepatitis B vaccine. Empiric treatment for sexually transmitted infections is given, laboratory tests are ordered, and HIV postexposure prophylaxis is started. After 24 hours, the laboratory test results for the survivor and assailant become available; based on these results, the HIV postexposure prophylaxis (PEP) is discontinued. The results are shown below

Table 1.
Baseline Laboratory Testing
Laboratory Test	Sexual Assault Survivor	Alleged Assailant
Hepatitis B surface antibody (anti-HBs)	Negative	Negative
Hepatitis B surface antigen (HBsAg)	Negative	Positive
Hepatitis B core antibody (anti-HBc)	Negative	Positive
Hepatitis C antibody	Negative	Negative
HIV-1/2 antigen-antibody	Negative	Negative

Which one of the following would be the recommended approach to prevent hepatitis B virus (HBV) infection for this woman?

No HBV PEP is indicated because the risk of HBV sexual transmission is insignificant

She should receive the HBV vaccine series, with an initial dose of HBV vaccine now

She should receive hepatitis B immune globulin (HBIG) now in combination with the HBV vaccine series, with the initial dose of the HBV vaccine administered now at a different site than where HBIG is administered

She should receive hepatitis B immune globulin (HBIG) now, followed by another dose of HBIG in 4 weeks

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Question Last Updated
June 23rd, 2025

Table 1.
Baseline Laboratory Testing
Laboratory Test	Sexual Assault Survivor	Alleged Assailant
Hepatitis B surface antibody (anti-HBs)	Negative	Negative
Hepatitis B surface antigen (HBsAg)	Negative	Positive
Hepatitis B core antibody (anti-HBc)	Negative	Positive
Hepatitis C antibody	Negative	Negative
HIV-1/2 antigen-antibody	Negative	Negative

Table 2.
HBV Nonoccupational Postexposure Prophylaxis Following Sexual Assault
HBV Status of Sexual Assault Survivor	HBsAg Status of Assailant
HBV Status of Sexual Assault Survivor	HBsAg Positive	HBsAg Status Unknown	HBsAg Negative
Unvaccinated	HBIG x 1, and HBV vaccine series (first dose now)	HBV vaccine series (first dose now)	HBV vaccine series (first dose now)
Partially vaccinated	HBIG x 1, and complete HBV vaccine series	Complete HBV vaccine series (give next dose in series now)	Complete HBV vaccine series (give next dose in series now)
Fully vaccinated but response to vaccine unknown	HBV vaccine booster dose x 1 (give dose now)	HBV vaccine booster dose x 1 (give dose now)	No treatment
Fully vaccinated with documented response to vaccine*	No treatment	No treatment	No treatment
Vaccine nonresponder^{^}	HBIG x 2 (separated by 1 month)	HBIG x 2 (separated by 1 month)	No treatment
Abbreviations: HBV = hepatitis B virus; HBsAg = hepatitis B surface antigen; HBIG = hepatitis B immune globulin *HBV vaccine responder is defined as a person with anti-HBs ≥10 mIU/mL after completing the HBV vaccine series. ^{^}HBV vaccine nonresponder is defined as a person with anti-HBs <10 mIU/mL after ≥6 doses of HBV vaccine.

Source:

Tanner MR, O'Shea JG, Byrd KM, et al. Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV - CDC Recommendations, United States, 2025. MMWR Recomm Rep. 2025;74:1-56. [PubMed Abstract]
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Sexual assault and abuse and STIs: adolescents and adults. MMWR Recomm Rep. 2021;70(No. RR-4):1-187. [2021 STI Treatment Guidelines]
Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Sexual assault and abuse and STDs. MMWR Recomm Rep. 2015;64(No. RR-3):1-137. [2015 STD Treatment Guidelines]

Chlamydial Infections

Gonococcal Infections

Syphilis

Genital Herpes

Human Papillomavirus Infection

Pelvic Inflammatory Disease

Vaginitis

Mpox

Mycoplasma genitalium

Chlamydial Infections

Gonococcal Infections

Syphilis

Genital Herpes

Human Papillomavirus Infection

Pelvic Inflammatory Disease

Vaginitis

Mpox

Mycoplasma genitalium

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Sexual Assault and Abuse and STIsQuestion 8/10

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Baseline Laboratory Testing

Which one of the following would be the recommended approach to prevent hepatitis B virus (HBV) infection for this woman?

Baseline Laboratory Testing

HBV Nonoccupational Postexposure Prophylaxis Following Sexual Assault

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