P512: prevention of Pregnancy & STI

what is conception and what time frame does conception occur? 

conception is when sperms meet egg

Sperm can survive inside the body for a maximum of 5 days before ovulation starts, so it occur during a 6 day window that begins 5 days before ovulation.

How are STIs contracted?

Contact with infected genital tissues, mucous membranes, and/or body fluids

Who are more likely to develop reproductive consequences?

Women are more prone to reproductive consequences and related conditions

What vaccines are available to decrease the risk of STIs?

HPV ( human papillomavirus vaccine) (e.g. Gadasil-9)

Hepatitis B Vaccine

What STI are not curable but preventable by vaccine?

Genital Warts & Hepatitis B

What STI are not curable?

HIV

Genital Herpes

Hepatitis C

What STI is curable and not curable

Some hepatitis C genotypes are curable with antiviral therapy

How is the effectiveness of contraceptive methods preventing pregnancy reported?

• Perfect use: Use contraception correctly and consistently but method itself is wrong

• Typical use: how people use in real life (e.g. missed pills or incorrect use)

What is the most effective way to avoid contracting an STI?

Either avoid risky sex or be in a long-term monogamous relationship with an uninfected partner

What are strategies for decreasing the risk of contracting an STI?

A-B-C-D-V strategy

A - Avoidance (Risky Situations)

• Abstain from sexual activity (the only 100% effective method).

• Avoid sexual activity if signs/symptoms are present.

• Avoid contact with body fluids (blood, semen).

• Avoid sharing sexual devices (if they touched body fluids).

B - Barriers (Protection)

• Use a fresh condom for every episode (anal, oral, or vaginal).

• Choose safe methods (latex/synthetic condoms); exclude lamb cecum/natural membrane as they don't protect against STIs.

C - Choices & Communication (Partners)

• Seek a mutually monogamous relationship with an uninfected partner.

• Avoid intercourse with partners who have multiple other partners.

• Avoid intercourse with a known infected partner.

• Discuss the partner's past sexual experiences.

D - Detection (Examination)

• Examine partner for genital lesions before contact.

• Practice genital self-examination regularly.

V - Vaccination

• Get vaccinated for vaccine-preventable STIs (e.g., HPV and Hepatitis B) if you are in a high-risk group.

What behaviors are associated with increased risk of condom breakage? 

The "R-I-S-K-S" of Condom Failure

• R – Roughness & Reuse

  • Reuse: Never reuse condoms.

  • Roughness: Longer, more intense, or more frequent sexual activity increases breakage risk.

• I – Incorrect Use & Fit

  • Incorrect Placement: Failing to squeeze air from the tip or placing it wrong.

  • Ill-fitting: Using a condom that is too tight or too loose.

• S – Substances & Sharps

  • Substances (Lube): Using oil-based lubricants with latex condoms (weakens them).

  • Substances (Drugs): Alcohol or drug use by either partner (leads to user error).

  • Sharps: Contact with sharp objects like fingernails or jewelry.

• K – Known History

  • History of Failure: If you have had breakage or slippage before, you are more likely to have it again (likely due to error).

  • History of STI: A history of STI is statistically associated with higher breakage rates.

• S – Short Duration

  • Short Relationship: Being in a relationship for less than 1 month is a risk factor.

What are the types of male condoms? female condom?

Latex, Polyurethane, Polyisoprene, Lamb cecum; FC2

What types of condoms are degraded by oil lubricant?

Latex, Polyisoprene

What condoms can be used when a patient has latex allergy?

Polyurethane, Polyisoprene, FC2

What is counseling point for FC2

Can be inserted up to 2 hours before intercourse but is

effective immediately upon insertion

Should nonoxynol-9 treated condoms be recommended?

• Nonoxynol-9 is a spermicide that kills sperms

• Nonoxynol-9 is not effective to prevent STI and pregnancy prevention

• Can cause irritation on vagina or penis that may increase infection risk

Should female and male condoms be used together?  Why?

No, may cause friction, thereby increasing the risk of breakage for either product.

What are the vaginal spermicides? How do they work?

Vaginal gel, foams, suppositories, contraceptive film, contraceptive sponge (polyurethane)

It acts as a physical barrier against sperm

Application methods for

• gel, foams, suppositories, film, sponge

what spermicides has immediate onset timing?

gel, foams, sponge

what spermicides are effective for 1 hour?

gel, foam, suppositories

what spermicides are effective for 3 hour?

film

what spermicides are effective for 24 hour?

sponge; must leave sponge in place for

at least 6 hr after intercourse but

not more than 30 hr

Pros and Cons for vaginal gel alone

Pros and Cons for vaginal foams alone

Pros and Cons for vaginal suppositories alone

Pros and Cons for vaginal contraceptive film

Pros and Cons for sponge

What is contraindication of gel, foam, suppository, film

anatomic abnormality of vagina * hard to place in cervix

What is contraindication of film

do not place over penis as this prevents proper placement and adequate time for dissolution

What is contraindication of sponge

1. supermicide sensitivity

2. anatomic abnormalities

3. during menstruation

4. less than 6 weeks postpartum or history of toxic shock syndrome

5. previous pregnancy —> parous women

Are spermicides effective at preventing pregnancy and/or STI transmission?

Low effectiveness rate for spermicides when used alone

** Persons with known risk factors for STIs should use it with condom

When should spermicides be recommended or not recommended?

1. Recommended if want additional protection other than condom

2. Person with STI should use it with condom to prevent pregnancy

What are the fertility awareness-based methods

calendar method, cervical mucus methods, symptothermal method, lactational method, coitus interruptus (withdrawal), home tests for ovulation prediction

What are the characteristic of calendar methods

Who are the candidate for calendar method?

What are the characteristics of cervical mucus method

Who are the best candidate for cervical mucus method

No restriction on candidate; best to be properly trained on interpretation of mucus

What are the characteristics of symptothermal method

who are the candidate of symptothermal method

What is the characteristic of lactational amenorrhea method

who are the candidate and what to consider for lac method

---

must be breastfeeding to see the effect of this method; no pumping

what are the characteristics of coitus interruptus

what are the consideration of withdrawal method

Requires considerable self-control by the man,

no STI protection and potential for diminished

pleasure

What are the characteristics and consideration of home tests for ovulation prediction?

• not recommeded for preg prevention

What are the emergency contraception?

Levonorgestrel (progestin): OTC

Ulipristal Acetate ( Rx)

Copper IUC (Rx)

Counseling point for Levonorgestrel (progestin): OTC

1. direction

2. side-effect

1. take one tablet (1.5mg) within 72 hours after unprotected intercourse or contraceptive failure although may dose up to 120hrs after

2. nausea and vomiting is common with use; if vomiting occurs within 1-2 hours after taking dose, then dose may be repeated

Levonogestrel (OTC) chracteristics

progestin; efficacy may not be maximal with BMI> 26kg/m² but should still be offered regardless of BMI

Ulipristal Ace characteristics

• Progesterone antagonist; blocks binding of progesterone to

progesterone receptor, thereby altering endometrial

formation and hindering implantation of fertilized ovum

• Efficacy declines with BMI > 30, may be ineffective at BMI

of 35, but should still be offered regardless of BMI

Counseling point for UAce

1. direction

2. side-effect

Take one 30 mg tablet ASAP within 120 hours (~5 days)

after unprotected intercourse or contraceptive failure

N/V is common with use; if vomiting occurs within 3 hours

of taking dose, then dose may be repeated

Copper IUC characteristics

1. No issue with BMI

2. copper ions released induces inflammatory response that results in demise of spermatozoa and hinders fertilization

What technology can be used to prevent the pregnancy?

1. Natural cycle app

How does natural cycle app works

1. detects slight increase in basal body temperature (BBT) during and after ovulation

2. Temperature is take in the morning before getting out of bed and is susceptible to the same factors as the sympothermal method

3. algorithm incorporates BBT, termperature fluctuations, and menstrual cycle irregulaties as well as sperm survival rate —> take about one to three cycles to understand the cycle and improves over time

Pros and Cons of Natural Cycling App

Pros =

“perfect use” failure rate is 1 out of 100 women who used the method for 1 year;

“typical use“ failure rate is 6.5-7 per 100 women who

use it for 1 year

● Cons = Does NOT protect against STIs

What are the online services for oral contraceptive

"A.C.C.E.S.S." to Online Birth Control

• A – Assessment Required

  • Patients must fill out a health assessment/questionnaire before getting a prescription.

• C – Cost is "Optimized"

  • Prices are reasonable (approx. $30/month).

  • Note: Most services do not accept health insurance.

• C – Consultation Fees

  • Be aware that some companies charge an extra fee for the consultation or prescription service.

• E – Eliminates the Doctor

  • Removes the "hassle" of making an in-person doctor's appointment.

• S – State Regulations Vary

  • Rules and availability depend on the state you live in.

• S – Specifics Vary (Age & Supply)

  • Age limitations and the Day Supply (how many months you get at once) vary by company.

What is the name of resources for where patients may obtain prescription OC’s online >

Free the Pill

Name Two online resources for STI testing kits

1. at home: available for order and test HIV chlamydia gonorrhea hepatitis herpes simplex; some kits can have 5-7 panel tests and check for multiple stis

2. testing sites: offer by CDC and planned parenthood

What and why Vitamin is important for pregnant women

Folic acid (B9) that prevent neural tube defects

What does of folic acid is good for all pregnant women

according to the american college of obstericians and gynecologists, they recommend 400mcg per day; good source when pregnant women cannot obtain them from the food

If a sexually active patient is not at risk for pregnancy AND not at risk for STIs, what is the recommendation?

No intervention; However, you must reassess if the situation changes.

Which barrier method is recommended for a patient at risk for STIs who has no latex allergy?

Latex external (male) or internal (female) condoms.

(Note: The chart explicitly says to exclude lamb cecum due to price).

What materials should be recommended if the patient is at risk for STIs but is allergic to latex?

Polyurethane or Polyisoprene condoms (external or internal).

According to the chart, when should "Natural family planning methods" be the primary recommendation?

Only when the patient has religious or personal objections to chemical, hormonal, or barrier contraceptives.

If a patient wants to prevent pregnancy and desires a method that does not require action at the time of coitus (sex), what is recommended?

Ongoing Rx contraceptives (e.g., the pill, patch, ring, etc.).

If a patient is at risk for both unintended pregnancy and STIs but does not have latex allergy, what is the combination recommendation?

Use a Condom (Latex or Synthetic) ± Spermicide or Rx Contraceptives.

(This ensures protection against both infection and pregnancy).

True or false: coitus interruptus offers protection against pregnancy and STIs.

• Coitus interruptus is the penis is withdrawn from the vagina before ejaculation.

• False, pre-ejaculation (쿠퍼액) can cause pregnancy and the absence of sti protection

What is the typical shelf life of packaged condoms under optimal storage conditions? What are signs that condoms should be discarded, even if they are within their expiration date?

• Optimal: 3-5 years

• Discard when signs of discoloration, brittleness, or stickiness observed

What are the most common complaints of female condoms?  What can be done to resolve these problems?

• Vaginal irritation and increased noise (“squeaking”).

• Decreased sensation or even discomfort, which is caused by the outer ring during intercourse

• Additional lubrication may resolve those problems

What are the most frequent complaint of male condoms?

• Decreased sensitivity of the glans penis, decreasing sexual pressure

• Sensitive to the condom material