St. Croix Valley SART, Inc.
Medication Policy and Standing Orders
Prophylactic treatment of sexually transmitted infections and emergency contraception will be
offered to all patients seeking medical services from the SART Forensic Nurse Examiner
following unprotected coitus or other possible exposure to Sexually Transmitted Infections as
determined by Forensic Nurse Examiner or RN. All patients offered prophylactic treatment for
STI’s and pregnancy will be screened for drug allergies, existing pregnancy, pregnancy risk, and
absolute contraindications documented in the medical forensic examination health history.
Sexually Transmitted Infections:
1. Zithromax 1000mg PO x 1 dose (Chlamydia)
2. Suprax 400 mg PO x 1 dose (Gonorrhea)
Allergies/pregnancy:
Chlamydia
1. Erythromycin base 500mg PO QID x 7 days OR
2. Erythromycin ethylsuccinate 800 mg PO QID x 7 days OR
For non-pregnant women
a) Doxycycline 100 mg PO BID x 7 days OR
b) Ofloxacin 300 mg PO BID x 7 days OR
c) Levofloxacin 500 mg PO BID x 7 days
Gonorrhea
a) Ceftiraxone 125mg IM in a single dose OR
b) Ofloxacin 400 mg PO in a single dose OR
c) Levofloxacin 250 mg PO in a single dose
Emergency Contraception: Give as directed
1. Products containing levonorgestrel only (including Plan B and others) or
2. Products containing ethinyl estradiol + levonorgestrel (including Preven)
Facility Medical Director: _____________________________________ Date: ______________
SART Executive Director: ______________________________________Date: ______________
Kristi Pavek, RN
1
1343 NORTH MAIN ST. RIVER FALLS, WI. 715.425.6443
INFO@STCROIXVALLEYSART.ORG WWW.STCROIXVALLEYSART.ORG