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
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
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)
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
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
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
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
8
Q
Latex Condoms
A
- Come in various sizes, colors, styles, shapes, etc.
- Range from 25 cents to $1.50 each
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
10
Q
Polyisoprene Condoms
A
- More elastic than Polyurethane
- Degraded by oil-based products
- $1.50-2.50 each
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
12
Q
Behaviors Increasing Condom Breakage
A
- Incorrect placement of condom/failure to squeeze air from the tip
- Use of oil-lube with latex condoms
- Reuse of condoms
- Increased duration, intensity, or frequency of coitus
- Prior history of condom breakage/slippage
- History of STIs
- Contact with sharp objects
- Self-reported problem with condom fit
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
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
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