Prevention of Pregnancy and STIs Flashcards
What is pregnancy?
- Estimated likelihood from unprotected sexual intercourse during the ovulation period ranges from 5-45%, with peak risk occurring the day before ovulation
- Pregnancy can occur despite contraceptive use if the product is used incorrectly, or it fails
What are STIs?
- Sexually transmitted infections
- Contracted through contact with infected genital tissues, mucous membranes, and/or body fluids
- A sexually activve person who presents with symptoms consistent with an STI is not a canddiate for self-treatment–> refer to healthcare provider
STIs affect both sexes, but women are more prone to reproductive consequences and related conditions, such as:
* Pelvic inflammatory disease, chronic pelvic pain, pregnancy complications, malignancies, and infertility.
* Likelihood possibly related to difficulties in diagnosis, lack of pt recognition of symptoms, and a higher probability of asymptomatic infection in female pts
Describe anogenital warts.
- Noncurable but vaccine preventable
- Caused by HPV
- Pathogen type: DNA virus
- The incubation period is months to years after acquiring
- Symptoms: commonly ASx, warts on external genitalia, rectum, anus, perineum, mouth, larynx, vagina, urethra, cervix.
- Treatment: Cryoablation (chemical or physical antimitotics, caustic agents, sinecatechins, immunomodulators.
- Complications: Cervical dysplasia, neoplasia, anogenital cancers, orophyrngeal cancer
Describe chlamydia
- Curable
- Caused by chlamydia trachomatis
- Bacterium
- The incubation period is several weeks
- Male symptoms: ASx to urethritis, urogenital discharge, itching, dysuria
- Female symptoms: ASx to vaginal discharge, postcoital bleeding, cervicitis
- Treatment: antibiotics
- Complications: PID, ectopic pregnancy, infertility
Describe gonorrhea.
- Curable
- Caused by neisseria gonorrhoeae
- Bacterium
- Incubation period is up to 14 days
- Symptoms: Urethritis, cervicitis, proctitis, pharyngitis
- Male: mucopurulent urethral discharge
- Female: commonly ASx
- Treatment is antibiotics
- Septic arthritis, perihepatitis, endocarditis, meningitis, PID,
infertility, ectopic pregnancy
Describe Hepatatis C.
- Curable
- Caused by Hep C virus
- Virus
- Incubation period 8-11 weeks
- Symptoms: ASx or mild clinical illness
- Can be treated by antivirals
- Complications: cirrhosis, hepatocellular cancer
Describe nongonococcal urethritis
- Curable
- Varous, including Chlamydia trachomatis, trichomonas vaginalis, mycoplasma sp.
- Bacteria
- The incubation period varies
- Symptoms: male–> nonspecific urethritis, discharge, dysuria, pruritus
- Treatment: Antibiotics
- Complications: Epididymitis, proctitis, proctocolitis, Reiter syndrome
Describe syphilis.
- Curable
- Caused by treponema pallidum
- Pathogen type: spirochete
- Types: Primary, secondary, tertiary
- Incubation periods: primary–> 21 days avg, secondary–> 4-12 weeks after initial infection, tertiary–> 10-30 years after initial infection (rare), neurosyphilis–> potentially life threating complication
- Symptoms: Primary—> a single, round, painless, usually hard sore (chancre), appearing on the genitals, anus, or elsewhere
- Treatment: antibiotics
- Complications: Secondary: skin rash, swollen lymph nodes, fever, and patchy hair loss. Tertiary: gummatous lesions and damage to multiple organs – brain,
nerves, eyes, liver, heart, blood vessels, bones, and joints. Neurosyphilis: Treponema pallidum bacterium invades the brain and/or
spinal cord–>CNS infection
Describe trichomoniasis
- Curable
- Caused by trichomoniasis vaginalis
- Protozoan
- Incubation period varies; 5-28 days
- Symptoms: Males–> commonly ASx, Females–> ~50% ASx, unpleasant smell, frothy green vaginal discharge, itching, dyspareunia, postcoital bleeding
- Treatment: antibiotics
- Complications: Pregnancy–> preterm labor, low birth weight
Describe AIDS.
- Acquired immunodeficiency syndrome
- Noncurable
- Caused by Human Immunodeficiency virus
- Virus= pathogen type
- Incubation period is up to 10 years
- Symptoms: flulike initially–> ASx until opportunitistic infections occur
- Treatment–> antivirals; prophylaxis + treatment for OIs
- Complications–> OIs, malignancies, death
Describe genital herpes.
- Noncurable
- Herpes simplex, HSV-1, HSV-2
- HSV-1: more commonly associated with oral herpes (cold sores)- passed via mouth to mouth contact
- HSV-2: more commonly associated with genital herpes- passed through sexual contact, but can be passed to other parts of the body through oral sex
- Pathogen type: virus; highly contagious
- Incubation period is 2-12 days
- Symptoms: ASx or vesicular; watery blisters on the skin and mucous membranes of the mouth, lips, nose, genitals, rectum, and eyes
- Treatment: antivirals
- Complications: spread of infection, pneumonitis, hepatitis, meningitis, encephalitis
What vaccines exist for STI prevention?
- HPV Vaccine
- Hep B Vaccine
What are the characteristics of the HPV vaccine?
- HPV infection is the most common STI in the US, with ~14 million
new cases annually - Risk of HPV infection is highest during the first few years after initiation of sexual activity
- More than 120 different subtypes of HPV have been identified
- Gardasil 9 – only HPV vaccine marketed in the US; effective against nine HPV types
- Approved for use in females and males 9-45 years old
- Vaccine works best prior to any HPV exposure from sexual contact
When is recommended to get the HPV vaccine?
- Recommends all 11 to 12 y.o. adolescents recieve applicaple HPV vax, recommending 2 dose series at 0 and 6-12 months for adolescents up to 15 y.o.
- Greater than 15 y.o.: 3 dose series recommended at 0, 1-2 months, and 6 months.
- Immunocompromisied conditions: recommends a 3-dose series at 0, 1-2 months, and 6 months
- A “catch-up immunization series is recommended for all unvaxed persons through 26 y.o.
- 27-45 y.o.–> may be appropriate with shared decision making
What are the characteristics of Hep B Vaccine?
Hepatitis B infection
○ Associated with long-term complications – hepatitis, cirrhosis,
hepatic carcinoma, death
○ Transmitted through blood and other body fluids, high-
risk sexual behaviors, usage of injectable drugs
Administration Schedules (based on the vaccine formulation)
○ Engerix-B: 3-dose series at 0, 1, and 6 months
○ Recombivax HB: 3-dose series at 0, 1, and 6 months; can be given as a 2-dose series separated by 4-6 months only for adolescents 11-15 years
○ Heplisav-B (licensed only in >18 years): 2-dose series at 0 and
1 month
○ PreHevbrio (licensed only in >18 years): 3-dose series at 0, 1,
and 6 months
What types of patients are eligible for a Hep B vaccine?
Due to Sexual Exposure:
* Hep B infected persons
* Those not in monogamous sexual relations
* Those in need of evaluation or treatment of STI
* Males who have sex with males
Other Candidates:
* Injection drug users
* Household contacts of those testing positive for Hepatitis B
* Health care and emergency response personnel
* Patients with diabetes
* End-stage renal disease
* HIV infection
* Hepatitis C infection
* Liver disease
* International travelers
* Residents of correctional facilities
* Facilities for developmentally disabled persons
What are the phases of the menstrual cycle?
- Follicular phase
- Luteal phase
What is the goal of contraceptives?
- to prevent unintentended pregnancy with minimal adverse effects and possibly prevent STIs
- No method of birth control is 100% effective, except abstinence.
What is the most effective way to prevent STI transmission?
- Abstain from high-risk sexual activity or maintain a long-term, mutually monogamous relationship with an uninfected partner
What are the two ways that the effectiveness of contraceptives are reported?
- The accidental pregnancy rate in the first year of perfect use (accurate and consistent use; method-related failure rate)
- The rate in the first year of typical use (inconsistent or incorrect use; use-related failure rate)
What are factors affecting contraceptive methods?
- Religious beliefs
- Future reproductive plans
- Product effectiveness
- Partner’s preference and support
- Degree of spontaneity permitted
- Ease of use
- Product acceptability
- Need for STI prevention
- Cost
What are prevention strategies for STIs?
- Abstain from sexual activity
- Avoid intercourse with a known infected partner
- Avoid intercourse with an individual having multiple sex partners
- Use a fresh condom
- Seek a mutually monogamous relationship with an uninfected partner
- Discuss partner’s past sexual experiences
- Examine partner for genital lesions
- Practice genital self-examination
- Avoid sexual activity involving direct contact with blood, semen,or other body fluids
- Avoid sharing sexual devices that come in contact with semen or other body fluids
- Choose safe and effective methods.
- Avoid sexual activity if signs/symptoms of an STI are present
- Consider vaccination for persons at
high risk for a vaccine-preventable
STI
External condoms
- Rubbers, sheaths, prophylactics, safes, skins, or pros
- Most important barrier contraceptive that also protects against STIs with consistent use
- Available in several materials: latex, polyurethane, polyisoprene, and lamb cecum (natural membrane or skin)
- Available in various sizes, colors, styles, shapes, and thicknesses
- Other features: reservoir tips, ribs, studs, spermicide coating, lubrication
What increases the risk of condom breakage?
- Incorrect placement of the condom/failure to squeeze air from the
receptacle tip - Use of an oil-based lubricant with latex condoms
- Reuse of condoms
- Longer duration, increased intensity, and/or frequency of sexual intercourse
- Previous history of condom breakage or slippage
- History of STI
- Contact with sharp objects
- Self-reported problems with fit of condom
- Impaired or intoxicated state, from drugs or alcohol, in either partner
- Brief acquaintance, <1 month with the sexual partner
Internal Condoms
Protects against pregnancy and STIs
Similar in efficacy to latex external condoms in decreasing risk of STIs
Internal condom consists of an inner ring that secures the sheath by fitting
like a diaphragm over the cervix
Designed for one-time use
Cost: $7.50 each; more expensive than latex condom
The breakage rate of internal condoms has been found to be lower than that
of latex external condoms, but the slippage rate may be higher
Only type of internal condom available is the FC2, which is made of nitrile, a synthetic latex
Vaginal Spermicides
Use surface-active agents to immobilize and kill sperm
The gel and foam formulation act as a physical barrier against sperm
Effective spermicides include nonoxynol-9
Products differ in their application, method, onset, and duration of action
● Cost: $1.11-$2.00 per dose
● Clinical studies do not support a protective effect of vaginal spermicides against STI transmission
Major disadvantage: low effectiveness when used alone
Efficacy improves greatly if spermicides are used with barrier methods
Hormonal Contraceptives
Opill (norgestrel 0.75) – FDA approved in July 2023 as a nonprescription, progestin-only hormonal contraceptive
Norgestrel is highly effective in preventing pregnancy with a reported
perfect-use effectiveness rate of 98%
● Norgestrel does not protect against STIs
● The tablet is taken once daily at the same time each day
Missed dose: a delay in administration >3 hours from the scheduled dose
If a dose is missed, take the dose as soon as possible and continue on with regular scheduling
Use a back-up form of contraception for 48 hours after missed dose
Common adverse effects: nausea, irregular vaginal bleeding, breast
tenderness, and headaches
Contraindications to use: hx of breast cancer or current pregnancy
Do not use with other hormonal contraceptives
What are fertility awareness based months?
- Techniques used to determine an individual’s fertile phase of the menstrual cycle, during which time intercourse should be avoided or another method of contraception used.
- Do not protect against STIs.
Describe calendar methods.
- Use a monthly cycle length to calculate the fertile period.
Describe the calendar rhythm method
Calculates the first fertile day in a menstrual cycle by subtracting
18 from the number of days in the shortest cycle
The last fertile day is calculated by subtracting 11 from the number of days in the longest cycle
Individuals who have irregular periods are not a candidate for this method, because fertile days could be identified
mistakenly as infertile day
Describe the standard days method.
Recommended only for those with cycles between 26 and 32 days in length
The first day of menstruation is counted as day 1, intercourse should be avoided on days 8-19 of the menstrual cycle or another method of contraception should be used during this time
Describe the cervical mucous methods.
- Rely on detecting changes in cervical sectetions that take place during a nomral menstrual cycle
- Cervical mucus monitoring can adapt to cycle variability, making it a suitable option for patients with irregular menses.
- Vaginal foams, gels, creams, and douches will interfere with cervical mucus.
Describe the symptothermal method.
- Combines cervical mucus tracking with basal body temperature (BBT) monitoring
- Predicts ovulation by tracking changes in your body temp during your menstrual cycle; basal temp should be taken at the same time each day immediately upon waking.
- Most appropriate for those with regular menstrual
cycles, between 21-35 days in length
