Post-exposure prophylaxis prescription fill rate among STI-positive adolescent sexual assault patients in the emergency department

Purpose: Child sexual assault is a significant public health issue associated with potentially devastating physical and psychological consequences, including risk of sexually transmitted infections (STI). Post-exposure prophylaxis for gonorrhea, chlamydia, and trichomonas is recommended for adolescent patients. Given ongoing antibiotic resistance, guidelines recommend a 7-day course of antibiotics be given for prophylaxis against chlamydia and trichomonas, requiring prescriptions. We describe the pediatric population seen for acute sexual assault in the pediatric emergency department (PED) as well as prescription fill rates in adolescents who are positive for STI. Methods: A retrospective, single center, descriptive study of STI rates of patients, 0–17 years of age, as well as post-exposure prophylaxis (PEP) prescription fill rates of adolescent patients 12–17 years of age seen in the PED for evaluation of pediatric sexual assault from March 1, 2022 - Sept 1, 2024. A follow-up phone call was conducted on all patients positive for STIs. Data was obtained from a secure database maintained by the Sexual Assault Nurse Examiner (SANE) team and analyzed using descriptive and inferential statistical methods to assess prescription fill rates and associated demographic variables. Results: Of the total 459 patients seen for sexual assault evaluation, 41.6% were adolescents, 82.1% were female, and 44.4% were Hispanic/Latino. Overall, 39 (8.5%) patients tested positive for gonorrhea, chlamydia, or both; of these, 34 were adolescents. Of the 31 adolescent patients with an STI who were discharged, 23 (74.2%) received appropriate prophylaxis for gonorrhea, chlamydia, and trichomonas. Of the 17 patients who received prescriptions in the PED with known prescription outcomes, 12 (70.6%) filled their prescriptions, 10 (58.8%) started their medications, and 6 (35.3%) completed their medications. Conclusion: Our population had sub-optimal prescription fill rates, which is concerning given the consequences of untreated STIs. This study aims to provide data as a starting point to guide future interventions to improve prescription adherence in this vulnerable population.