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815 > Ch. 10 - Pregnancy and STI > Flashcards

Ch. 10 - Pregnancy and STI Flashcards

1
Q

Pregnancy and STIs

A
  • Unprotected sex can lead to pregnancy and STIs
  • ~49% of pregnancies are unintended
  • 19.7 million + are infected each year with new STIs
  • $16 billion in costs per year
  • Repeat pregnancies may be indicative of inadequate contraception use
  • 1 in 4 teenage girls are infected with 1 or more STIs
  • Increase pregnancy and STI risk in older population, especially when non-monogamous
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2
Q

Pregnancy/STI Pathophysiology

A
  • Only when a viable eff is available to be fertilized by sperm
  • Conception has a 6-day window starting 5 days after ovulation
  • Risk of pregnancy from unprotected sex during period ranges from 5-45%
  • STIs contracted with infected genital tissue, mucus membranes, and/or body fluids
  • Women more likely to develop reproductive consequences from STIs
  • Pregnancy-related complications increase with STIs
  • Transmission rates differ between sexes
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3
Q

HPV

A
  • STI that can cause cervial, penile, anal, throat, and other cancers
  • 100 different types of virus
  • Type 16 & 18 cause 70% of cervical cancers, Types 6 & 11 cause 90% of genital warts
  • 14 million new cases each year
  • Gardasil (quadvalent) - targets types 6, 11, 16, and 18, indicated for girls and boys 9-26 y.o., 3 doses
  • Cervarix (bivalent) - only targets types 16 and 18, indicated for girls/women 9-25 y.o., 3 doses
  • Need all 3 doses for maximum immunization
  • Works better before having intercourse
  • ACIP recommends giving vaccine to 11-12 y.o. girls
  • ASE: irritation, malaise, and syncope (monitor for at least 15 minutes post-injection)
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4
Q

Hepatitis B

A
  • Can cause long term complications including hepatitis, cirrhosis, hepatic carcinoma, and death
  • Can be spread be coming in contact with blood, body fluids, or during sex
  • Inactivated, injectable vaccine administered at 0, 1, and 6 months
  • Recommended routine vaccination for all infants but also given to kids and adolescents
  • Adults who meet risk criteria like multiple sexual partners, injection drug users, HC & ER response personnel, diabetics, end stage renal disease, or drug/HIV treatment facility dwellers can also be given the vaccine
  • Can be given by pharmacist depending on state law and age limits
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5
Q

Contraception

A
  • Prevent unintended pregnancies and STIs with minimal adverse side effects
  • No contraceptive method is 100%
  • Effectiveness is reported in accidental pregnancy rate in the first year through perfect use and first year of typical use
  • Perfect use is indicative of method’s theoretical effectiveness
  • More realistic use includes pregnancies due to incorrect or inconsistent use
  • Effectiveness increases as method use increases
  • Abstaining from sex or involvement in long-term monogamous sexual relationships with an uninfected partner are most effective for not getting STIs
  • Best method = preventative strategies in conjunction with selective contraceptives
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6
Q

Selection of Contraception

A
  • Acceptability is vital for consistent and correct use
  • Factors affecting acceptability: user’s religious beliefs, future reproduction plans, product effectiveness, partner’s preference/support, degree of interruption of spontaneity, ease of use, accessibility, and cost
  • Go over these factors with patients and their possible adverse reactions or affects on future conception
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7
Q

Male Condoms

A
  • Most important barrier defense against STIs
  • Must meet FDA performance standards for strength and integrity
  • Breakage may range from 0-22% and could be user or manufacturing error
  • Use of lube is questionable
  • Two studies reported SIGNIFICANTLY high preggo rates with non-latex condoms
  • Only use non-latex in those with latex allergies
  • Failure rates decrease with increased use, starts at 15%
  • Spermicide condoms discourages due to possible irritation and no additional STI prevention benefits
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8
Q

Latex Condoms

A
  • Come in various sizes, colors, styles, shapes, etc.

- Range from 25 cents to $1.50 each

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9
Q

Polyurethane condom

A
  • Conducts heat well, but not as elastic as latex
  • Not degraded by oil-based products
  • $1.50-2.50 each
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10
Q

Polyisoprene Condoms

A
  • More elastic than Polyurethane
  • Degraded by oil-based products
  • $1.50-2.50 each
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11
Q

Lamb Cecum Condoms

A
  • Only for preggo prevention
  • Pores may allow passage of STI viral organisms
  • Conducts heat well, not degraded by oil, strong
  • ~$3 each
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12
Q

Behaviors Increasing Condom Breakage

A
  1. Incorrect placement of condom/failure to squeeze air from the tip
  2. Use of oil-lube with latex condoms
  3. Reuse of condoms
  4. Increased duration, intensity, or frequency of coitus
  5. Prior history of condom breakage/slippage
  6. History of STIs
  7. Contact with sharp objects
  8. Self-reported problem with condom fit
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13
Q

Condom Storage/General Information

A
  • Keep packaged condoms in package until use and protect from light and excessive heat
  • Expiration: 3-5 years
  • Discard condoms that are discolored, brittle, or sticky
  • Encourage different style or brand use if condom was disliked by a patient
  • Use of thin, ridged, non-latex, or natural condoms with monogamous, non-STI partner may alleviate complaints of decreased sensitivity
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14
Q

Female Condoms

A
  • FC2 approved in 2009, made of nitrile, took place of FC1
  • Outer ring, sheath, or pouch that fits over vaginal mucosa and cervix
  • One time use
  • $2 each
  • Higher slippage rates but less breakage
  • Perfect user failure rate: 0.8-2.5%, initial rate: 12.5%
  • Equal efficacy as male latex condoms for STI transmission
  • Store at room temperature in unopened packages
  • Can be placed up to 8 hours before sex
  • Complaints: vaginal irritation, increased noise (squeaking), decreased sensitization, and increased discomfort
  • Don’t use with male condom, could increase friction and breakage
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15
Q

Vaginal Spermicides

A
  • Surface active agents that immobilize or kill sperm
  • Also a physical barrier when gel/foam
  • Nonovynol-9 - in all spermicides in the U.S.
  • Efficacy improves greatly when used with barrier contraception
  • Not proven to reduce STI transmission, may actually increase STI risk
  • May leave an unpleasant taste for oral sex
  • Frequent use of high concentration spermicides may irritate or damage vaginal/cervical epithelium which could increase STI risk
  • No notable increased risk of birth defects/miscarriages
  • Condoms + spermicides may have similar efficacy rates as oral contraceptives and UTIs
  • Don’t use in women with anatomic abnormalities
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16
Q

Vaginal Gels

A
  • “Jellies”
  • Can use with latex condoms
  • Applicators for convenience
  • Can be prefilled
  • Use higher concentrations for better outcomes
17
Q

Vaginal Foams

A
  • Distributes more evenly and adhere better to cervix/vaginal walls
  • Less lubrication
  • Hard to tell when container is empty
18
Q

Vaginal Suppositories

A
  • Solid or semisolid
  • Activated by moisture
  • Incomplete dissolution can cause a gritty sensation
  • May be better to refrigerate in warm climates
19
Q

Contraceptive Film

A
  • Paper thin
  • Activated by vaginal secretions
  • One film per intercourse
  • Don’t place over dick, more likely to be improperly placed and have not enough dissolution time
  • Most difficult to use but the least messy
20
Q

Contraceptive Sponge

A
  • Small, circular, disposable sponge made of polyurethane and spermicide
  • Mechanical barrier, spermicide, and absorbs sperm
  • Ranges $5-8 per sponge
  • Failure rate: 17.4-24.5%
  • Increased failure rate in those who have given birth before
  • If dislodged during sex, efficacy decreases
  • Doesn’t protect against STIs, may increase the risk of HIV due to ulceration
  • Must locate cervix and place sponge correctly over it
  • Can be placed up to 24 hours before sex, must stay in 6 hours after sex
  • May be hard to remove and fragment upon removal
  • Vaginal dryness reported
  • Increase risk of toxic shock syndrome
  • Don’t use in those on period, <6 weeks postpartum, or has a history of TSS
  • Don’t leave in for more than 30 hours
  • Fragments may cause infection if not removed
  • CI: parous women (difficulty covering cervix)
21
Q

Emergency Contraception (EC)

A
  • Hormones in tablets or non-hormonal copper IUD
  • Prevents pregnancy within 3-5 days of unprotected sex
  • Hormones: progestin only, estrogen + progestin, or selective progesterone receptor modulator
  • Currently Rx and OTC
  • No progestin+estrogen products available
  • Recommend health care appointment and law enforcement reporting if sexual assault involved
22
Q

Ella

A
  • 30 mg ulipristal acetate
  • Selective progesterone receptor modulator
  • Rx only
  • Works up to 5 days after sex
  • Similar counseling to progestin products
23
Q

Plan B and Derrivatives

A
  • Levonorgestrel tablet, 1 or 2 tablet plans
  • $40-50 for single use
  • Increased effectiveness when also taking birth control
  • Mainly inhibits ovulation, but can also increase mucus secretions to block sperm/egg transport
  • Available OTC for 18+ in 2006, 17+ in 2009, 2013 the age limitations removed and is available for all ages (under 17 need Rx)
  • Need to take within 3 days of sex, may be effective at day 5 too
  • Give ASAP and take 2nd dose (if there is one) in 12 hours
  • ASE: N/V (more prominent when taking birth control), headaches, breast tenderness, and dizziness
  • May use antiemetic 60 min. before dose to reduce this
  • If you vomit within 1-2 hours of taking medication, need to retake dose
24
Q

Copper IUD

A
  • Use up to 5-7 days after unprotected sex

- Can be inserted up to day 8 but usually limited to 5 days after sex by medical professionals

25
Q

Fertility Awareness Methods

A
  • Don’t use chemicals or barriers
  • Include calendar methods, cervical mucus methods, symptothermal methods, and lactation amenorrhea method (LAM)
  • Usually chosen since no health risks, costs, or effects on religious preferences
  • Lacks STI protection and efficacy
  • May need condoms for fertile days
26
Q

Calendar Methods

A
  • Use menstrual cycle to calculate fertile periods
  • Since cycles vary, record them for 6-12 cycles to predict the range of fertile days
  • Rhythm Method: first fertile days = # days of shortest cycle - 18; last fertile day = # days of longest cycle - 11
  • Not good for irregular cycles
  • Standard Days Method: good for only cycles between 26-32 days, avoid intercourse days 8-19 or use contraception during these days
  • Can use software to help track cycles
27
Q

Cervical Mucus Methods

A

-Relies on consistent cervical mucus changes to take place during menstrual cycles

28
Q

Billings Ovulation Method

A
  • Observes cervical mucus daily and charts character/amount
  • Most get vaginal dryness post-period
  • 5-6 days before ovulation, estrogen increases and causes increased clear, elastic secretion similar to raw egg whites, last day of this occurs within a day of ovulation (peak symptom)
  • As progesterone raises with ovulation, secretions become thick, sticky, or absent
  • Avoid sex the first day mucus is detected after period to 4 days after peak symptom appears
  • Inform about gels, creams, or douches that interfere with cervical mucus
29
Q

Creighton Model

A
  • Similar to Billings Ovulation but has a more standardized definition of cervical secretions
  • Involves the male partner
  • Requires training
30
Q

Two-Day Method

A
  • Monitor secretions on a daily basis
  • Any secretions that day and the day before means likely fertile
  • No secretions means likely infertile
  • More simplistic method
31
Q

Symptothermal Method

A
  • Combines fertility awareness methods
  • Track secretions and BBT
  • Secretions show onset of fertile period
  • BBT shows end of fertile period
  • Need to record temperature every morning, preferably with a digital thermometer calibrated to 0.1 degree Fahrenheit
  • Must record before getting out of bed at the same time every day
  • Need at least 3 hours of uninterrupted sleep
  • Can be oral, vaginal, or rectal measurements, but has to be the same EVERY time
  • In some, BBT drops 12-24 hours before ovulation and rises by at least 0.4 degrees at ovulation
  • Infertile period: 3 days of raised temperature until the end of menses
  • Some women don’t get the temperature changes and outside factors can affect BBT
  • Those with rotating shifts may not be able to meet sleep and measurement requirements and should use a different method
32
Q

Home Ovulation Predictions

A
  • Designed to aid in conception by detecting surge in lutenizing hormone before ovulation
  • Urine kits that detect this hormone’s increase that occurs 8-40 hours before ovulation
  • Not accurate enough to use to avoid pregnancy
33
Q

LAM

A
  • Used to space birth of children
  • In first 6 months, mom is BF and is amenorrheic, protect 98% of population from pregnancy
  • Need frequent, suckling action for protection so breast pumps don’t provide the same protection
  • Use additional contraception if you get your period, are supplementing the infant’s diet elsewhere, or are >6 months postpartum
  • Preggo rates with LAM: 0.5-2%
34
Q

Effectiveness of Fertility Methods

A
  • Overall preggo rate of FAB: 24%, higher than all others
  • No STI protection, so better for monogamous partners
  • FAB with specific pre and post ovulatory descriptors have better outcomes (perfect use failure: 5%)
35
Q

Coitus Interruptus

A
  • Pulling out
  • Withdrawal during sex when ejaculation is imminent
  • Can have failure from involuntary preejaculation secretions
  • No STI protection
  • Disadvantages: self-control needed by man, potential for decreased pleasure for couple
  • Perfect use: 4%, typical use: 22%
36
Q

Assessment

A
  • Identify level of knowledge about pregnancy and STI risks
  • Those who prefer FAB need to understand the reproductive cycle
  • Non-Rx contraceptive users need to know how to use them properly and be ready to use them EVERY time
  • Help based on timing of use, religious restrictions, and cultural preferences
37
Q

Counseling

A
  • Discuss specific diseases and prevention strategies
  • Consult both partners if possible
  • Be familiar with proper use of non-Rx contraceptives and remove conversation barriers
  • Provide info on pregnancy and STIs in an accessible area
  • Can also help them gain access to other needed medical or social services
  • Special efforts to get adolescents accurate information, send to specialized clinics if uncomfortable in giving this information
  • Recognize present stigmas and misinformation
  • FAB need extensive education and training and should be for stable couples, may also need special equipment for these methods

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