Short answer
After sexual assault or any nonconsensual sexual exposure, STI testing is only one part of care. A sexual assault medical forensic exam can include injury care, documentation, evidence collection, STI information and treatment, pregnancy prevention, referrals, and follow-up. If HIV exposure is possible and the assault happened within 72 hours, ask urgently about HIV PEP. If pregnancy is possible and not desired, ask about emergency contraception. Initial STI tests can be useful, but follow-up testing may still be needed.
Care options at a glance
| Question | What to ask for | Why it matters |
|---|---|---|
| Immediate safety or injury | Emergency care, urgent care, or a sexual assault nurse examiner/forensic examiner when available. | Medical care can address injuries, safety, medications, and referrals. |
| Forensic options | Ask whether a SAFE exam or SANE exam is available and what choices you have. | DOJ describes SAFE as a medical forensic exam that can include documentation, evidence collection, treatment, and referrals. |
| STI exposure | Ask about baseline tests, presumptive treatment, vaccines, and follow-up testing. | CDC recommends routine presumptive STI treatment after sexual assault because follow-up can be difficult. |
| Possible HIV exposure | Ask about HIV PEP as soon as possible if care is within 72 hours. | CDC says PEP benefit is more likely when started early after exposure. |
| Possible pregnancy | Ask about pregnancy testing and emergency contraception. | CDC sexual assault guidance says reproductive-aged female survivors should be evaluated for pregnancy and offered emergency contraception. |
| Privacy, cost, or reporting concerns | Ask what care can be confidential, what may be billed, and what reporting rules apply in your state. | Rules can vary by state, age, injury, insurance, and care setting. |
What a SAFE exam can include
The U.S. Department of Justice describes a sexual assault medical forensic examination, or SAFE, as an exam by a clinician for a patient who has experienced sexual assault. It can include a medical forensic history, a comprehensive exam, injury treatment coordination, documentation, evidence collection, information and treatment for STIs, pregnancy prevention, safety and mental-health referrals, and follow-up. You can ask what each step involves before consenting to it.
Initial STI tests clinicians may consider
CDC says decisions about testing after sexual assault should be individualized. An initial exam may include chlamydia and gonorrhea NAATs at sites of penetration or attempted penetration. Females should be offered trichomoniasis NAAT testing from a urine or vaginal specimen, and testing for BV or yeast may be considered when vaginal discharge, odor, or itching is present. CDC also lists serum testing for HIV, hepatitis B, and syphilis.
The sample site matters. Vaginal, cervical, urethral, rectal, throat, urine, lesion, and blood tests answer different questions. If oral, anal, or genital contact happened or might have happened, ask which sites are being tested and whether any testing is baseline only.
Testing versus presumptive treatment
After sexual assault, clinicians may recommend treatment before all STI results are known. CDC says routine presumptive treatment is recommended after sexual assault because follow-up visits can be difficult. That is different from ordinary screening, where a clinician might wait for test results. If you are offered medication, ask which infections it covers, what side effects to watch for, whether it interacts with other medications, and what follow-up still matters.
HIV PEP and the 72-hour question
CDC says HIV PEP recommendations after sexual assault are made case by case according to risk. Risk assessment can consider penetration type, ejaculation on mucous membranes, bleeding or trauma, mucosal lesions, multiple assailants, local HIV epidemiology, and any known information about the assailant. If PEP is being considered, CDC emphasizes early initiation, ideally as soon as possible and within 72 hours after the assault. PEP care can include baseline HIV testing, kidney and liver labs, medication access, adherence support, and repeat HIV testing.
Pregnancy prevention and vaccines
If pregnancy is possible, ask about emergency contraception as soon as you can. CDC sexual assault guidance also discusses hepatitis B vaccination after exposure when vaccination status or source status creates a risk question, and HPV vaccination for survivors in the recommended age groups who are not vaccinated or incompletely vaccinated. Vaccination questions do not replace STI testing, but they can be part of the same visit.
Follow-up testing
CDC says follow-up after the initial exam can review test results, arrange treatment if it was not given initially, complete hepatitis B or HPV vaccination, monitor medication side effects, and support PEP adherence if PEP was prescribed. If initial tests are negative and treatment was not provided, CDC says STI testing can be repeated 1 to 2 weeks after the assault. If infection in the assailant cannot be ruled out, CDC says syphilis serology can be repeated at 4 to 6 weeks and 3 months, and HIV testing can be repeated at 6 weeks and 3 months using methods that identify acute HIV infection.
Questions to ask during care
- Is a SAFE or SANE exam available, and what parts of the exam are optional?
- Which STI tests are being done today, and which body sites are included?
- Are these results baseline results, or will I need repeat testing?
- Should I receive presumptive STI treatment today?
- Based on timing and risk, should I start HIV PEP within the 72-hour window?
- Do I need emergency contraception, pregnancy testing, hepatitis B vaccination, HPV vaccination, or other vaccines?
- How can I receive results and follow-up in the safest and most private way?
Related Lab Intel guides
For urgent exposure timing, see the condom break and possible exposure guide. For HIV medication timing, see the PrEP vs PEP testing timelines guide and the HIV testing window period guide. For body-site swabs, see the extragenital STI testing guide. For symptoms, see the STI symptoms versus routine screening guide. For privacy and access questions, see the STI testing privacy and insurance guide and the free and low-cost STI testing guide.
When screening recommendations matter more
Screening recommendations matter most when the assault involved more than one exposure site, when the first test happened very soon after the event, or when follow-up timing for HIV, syphilis, chlamydia, gonorrhea, or hepatitis testing needs a plan. CDC screening guidance helps separate the immediate exam from the later repeat-test schedule.
FAQ
What STI testing may be done after sexual assault?
CDC says an initial examination after sexual assault may include chlamydia and gonorrhea NAATs at sites of penetration or attempted penetration, trichomoniasis testing for females, testing for BV or yeast when symptoms are present, and blood tests for HIV, hepatitis B, and syphilis.
When does HIV PEP matter after sexual assault?
CDC says HIV PEP recommendations after sexual assault are made case by case according to risk, and discussion is most time-sensitive when care is sought within 72 hours after the assault.
Do I have to get a forensic exam to get STI care?
No. You can ask for medical care, STI testing, PEP, emergency contraception, or vaccines even if you do not want evidence collection. A SAFE exam can include several options, and you can ask what is optional before consenting.
Should emergency contraception be discussed after sexual assault?
Yes, if pregnancy is possible and not desired. CDC recommends discussing emergency contraception when the assault could result in pregnancy, and timing matters because different methods have different windows.
When are follow-up STI tests usually repeated?
If initial tests are negative and treatment was not provided, CDC says STI testing can be repeated 1 to 2 weeks after the assault. Syphilis serology can be repeated at 4 to 6 weeks and 3 months, and HIV testing can be repeated at 6 weeks and 3 months when source infection cannot be ruled out.
Can I choose which parts of the sexual assault exam I want?
Yes. You can ask what each part of the exam does, which pieces are optional, how samples are used, and how results will be shared before consenting.