An Evaluation of post-sexual assault care guidelines using the AGREE II toolkit with a focus on prophylactic antibiotic recommendations

OBJECTIVE: To evaluate nationally and internationally published, English-language clinical guidelines on the management of sexual assault, with a specific focus on the recommendations for antimicrobial prophylaxis for sexually transmitted infections, using the AGREE II toolkit and a bespoke assessment framework co-designed with survivors. METHOD: A comprehensive online search (Google, SAFEta, the TRIP database, and UpToDate) for clinical guidelines published in the past five years was performed and reported using the PRISMA guidelines. Four reviewers independently appraised each guideline using the appraisal of guidelines for research and evaluation (AGREE II) tool. An AGREE II domain score of >60% is the threshold for sufficient quality, and each guideline was rated high, average or low based on the domain percentages (five domains scoring >60%=high, 3-4 domains scoring >60%=average and ≤2 domains scoring>60%=low). A bespoke evaluation tool, developed with survivors, was applied to assess inclusive language, clarity of antimicrobial prophylaxis criteria, adherence considerations, antimicrobial stewardship, psychological impact, and follow-up guidance. RESULTS: Sixteen guidelines met inclusion criteria from the WHO, UK, USA, Ireland and Australia. The median overall AGREE II score was 65% (IQR 42-79). The overall AGREE II score was 69% (IQR 45-81) (domain 1 (scope and purpose) 89% (IQR=80-92), domain 2 (stakeholder involvement) 75% (IQR=68-76), domain 3 (rigour of development) 42% (IQR=32-57), domain 4 (clarity of presentation) 80% (IQR=72-85), domain 5 (applicability) 56% (IQR 48=63), domain 6 (editorial independence) 69% (IQR=45-81)). Three guidelines (WHO, BASHH-UK, CDC: USA) had a high overall rating and overall scores of 6. Six guidelines met all bespoke tool criteria: BASHH, CDC, Wales, USA, Scotland, and WHO. CONCLUSION: Future guideline development should prioritise editorial independence, developmental rigour, and applicability.