Birth Control - Fertility - STI

Question 1

IUD

Answer 1

Non-hormonal: Paragard (last 10 yrs)

Hormonal:
- Skyla (last 3 yrs)
- Kyleena (last 5 yrs)
- Mirena (last up to 8 yrs)
- LILETTA (last up to 8 yrs)

Effectiveness: 99.2 - 99.9% effective

Effective immediately if it was inserted within seven days after the start of your period. If IUD is inserted at any other time during your menstrual cycle, use another method of birth control, like condoms for at least 7 days.

Paragard is effective immediately.

SE:
- Spotting between periods (especially during the first few months after you get an IUD)
- Increased period flow (for users of the Paragard brand)
- Cramps and backaches
- IUD slipping out
- Infection
- IUD pushing through the wall of the uterus

Question 2

Implant (Nexplanon)

Answer 2

Last up to 5 yrs.

If you get Nexplanon during the first 5 days of your period, you’re protected from pregnancy right away. If not, use another birth control for the first week.

Effectiveness: 99.9% effective

SE:
**Irregular bleeding, especially first 6 - 12 months
Acne
Change in appetite
A change in your sex drive
Ovarian cysts
Depression
Discoloring or scarring on the skin over the implant
Dizziness
Hair loss
Headache
Nausea
Nervousness
Pain where the implant was inserted
Sore breasts

Question 3

Depo-Provera

Answer 3

Injection, Q3M

• Contains progestin, a hormone that prevents your ovaries from releasing eggs.

Effectiveness: 96% effective

You’re immediately protected after receiving the first Depo-Provera® shot if you get it during your menstrual period. If it’s given to you at another time during your cycle, you may need to wait a week to 10 days before having intercourse without a condom to prevent pregnancy.

SE:
- Irregular bleeding, especially for the first 6-12 months
- Change in appetite or weight gain (It’s common for some women to gain around 5 pounds in the first year, while other women gain nothing.)
A change in your sex drive
Depression
Hair loss or more hair on your face or body
Nervousness or dizziness
Headache
Nausea
Sore breasts

**If you still feel uncomfortable after the course of at least two shots in a row, switch methods

Question 4

Birth control patch

Answer 4

Patch needs to be changed once a week.

Effectiveness: 93% effective

If you start the patch within the first 5 days of your period, you’re protected from pregnancy right away. If you start later, you’ll have to wait 7 days before you’re protected, and you’ll need to use a backup method.

SE:
Nausea, irregular bleeding, sore boobs
Bleeding in between periods
Breast tenderness
Nausea and vomiting
Irritation where the patch sits on your skin
A change in your sex drive

Patches Xulane and Zafemy may be less effective if you weigh more than 198 pounds. (Random number, right?) If your BMI is 25 or greater, Twirla may be less effective at preventing pregnancy. And none of the patches are recommended if your BMI is 30 or greater because of decreased effectiveness and a potentially increased risk of blood clots.

Question 5

OCPS

Answer 5

Effectiveness: 93% effective

SE:
Most common are sore breasts, nausea, spotting, and decreased sex drive.
Bleeding in between periods
Sore breasts
Nausea and vomiting

Benefits:
Might give you lighter periods
Gives you control over when you have your period
Some pills clear up acne
Can reduce menstrual cramps and PMS

Question 6

Ring

Answer 6

Ring in. Wait 3 weeks. Ring out. Wait 1 week. Repeat.
(like putting a tampon)
Brands: NuvaRing (monthly), Annovera (yearly)
Effectiveness: 93% effective

SE:
Bleeding in between periods
Breast tenderness
Nausea and vomiting
Increased vaginal discharge, irritation, or infection
A change in your sex drive

Question 7

Chlamydia

Answer 7

Preferred regimen: Doxycycline 100 mg orally twice daily for 7 days
- Preferred regimen for nonpregnant individuals.
- Patients should be counseled on treatment adherence.
- Individuals of child-bearing potential should have pregnancy testing prior to taking.
- Generally avoided during pregnancy.

Alternative regimen
Azithromycin 1 g orally single dose (directly observed, if possible)
- Alternative regimen for nonpregnant individuals who cannot take doxycycline or may not be able to complete the full course.
- Preferred regimen for pregnant individuals.

Other alternative regimens
Levofloxacin500 mg orally once daily for seven days
- Reserved for nonpregnant individuals when other fluoroquinolone-susceptible pathogens need to be covered (eg, urethritis with possible gram-negative bacterial co-infection).
Generally avoided during pregnancy.

Amoxicillin 500 mg orally three times daily for seven days
- Alternative regimen for pregnant individuals who cannot use azithromycin.
- Not used in nonpregnant individuals because better alternatives are options.

Question 8

Neisseria gonorrhoeae

Answer 8

Preferred regimen: Ceftriaxone
Weight <150 kg: 500 mg intramuscularly as a single dose
Weight ≥150 kg: 1 g intramuscularly as a single dose

• Preferred regimen for all individuals.
• Most patients with a penicillin allergy can still use ceftriaxone safely. Depending on the type of allergy, options include:
  —Giving with or without skin testing
  —Giving with a test dose

Alternative regimens (IM)
- Ceftizoxime 500 mg intramuscularly as a single dose
- Cefoxitin 2 g intramuscularly with probenecid 1 g orally as a single dose
- Cefotaxime 500 mg intramuscularly as a single dose

Oral cephalosporin:
- Cefixime 800 mg orally as a single dose

Alternative regimens if ceftriaxone administration is not available or feasible.
Efficacy in pharyngeal infection is uncertain (cefixime is associated with treatment failure).
Certain agents are of limited availability.

Azithromycin-based regimens
Azithromycin 2 g orally as a single dose

PLUS
Gentamicin 240 mg if >45 kg (or 5 mg/kg if ≤45 kg) intramuscularly once
OR
Gemifloxacin 320 mg orally once

Alternative regimens, reserved for patients with urogenital or anorectal gonococcal infection who have severe allergies that preclude cephalosporin use.
Avoid in pharyngeal infection.
Gemifloxacin and spectinomycin are of limited availability.

Question 9

Late latent syphilis

Answer 9

After 1 year of infection or unknown time.

Preferred
Penicillin G benzathine 2.4 million U IM, once weekly for 3 weeks

or alternatively
- Doxy 100mg PO BID x 4 weeks
or
- Ceftriaxone 2g QD IM or IV for 10 -14 days

Question 10

Mycoplasma genitalum

Answer 10

Doxy 100mg PO BID x7days
followed by
Azithro 1 gm PO one day
followed by
Azithro 500mg PO x 3 days

for resistant strain:
Doxy 100mg PO BID x7days
followed by
Moxifloxacin 400mg PO QD for 7 days