Final Exam HDV

Conception

Thirty percent of fertile women engaging in sexual intercourse results in pregnancy.

What happens during ovulation

A mucus plug in cervix disappears and cervical mucus becomes thinner and stretchy

Unfertilized ovum lives for how long?

Approx 18-24 hours

How long may sperm live?

5-7 days but most are active in the first 48 hours

Ovum releases a chemical signal that does what to sperm?

Attracting sperm as sperm move through uterus into fallopian tubes.

Sperm secretes hyaluronidase an enzyme that thins the gelatinous layer after reaching ovum. Only one makes it inside before the cover thickens again. How long does fertilization take?

It takes about 24 hours and occurs in the opening to the uterus in the fallopian tube.

In the conception timeline how long before the zygote enters the uterus?

3-4 days

What day does the zygote implant in the uterine wall during conception?

Day 6

The placenta is a temporary gland that covers 20% of the uterine wall at 4 weeks and 50% at 5 months, What does it do for the fetus?

It connects to the fetus by umbilical cord, supplies nutrients, aids in respiratory functions, and secretes hormones.

Missing period, breast tenderness, frequent urination, morning sickness. 50-80% of pregnant women experience some form of nausea due to increase in estrogen that may irritate the stomach lining.

Early Signs of Pregnancy

**Pregnancy Testing:** (including over the counter) measure human chorionic gonadotropic (hCG) in the blood. How many weeks until you can finally tell if the test is positive?

Between 2 weeks after conception and max at week 12.

Is divided into 3-month periods called trimesters. Can vary from 38 to 40 weeks.

Pregnancy

Fetal “heart” cells form and begin to pump

4 weeks

1/2 inch from head to rump, as wide as a pencil earser.

6 weeks

Now a fetus. Size of a bean. Ears, nose, and lip become visible.

8 weeks

Tail and webbing disappear

10 weeks

Over 2 inches, teeth, fingers, and toes with nails. 78% of miscarriages

12 weeks

14 weeks

4 inches long and body covered in lanugo (soft hairs) fingerprints develop.

18 weeks

Sex can be determined by ultrasound, a waxy substance called vernix caseosa covers body.

20 weeks

6 1/2 inches long, can open and close eyes, mother gains 1/2 lb a week from now on

24 weeks

Perceive light, and sound, sleep and wake.

Age of Viability

Ability to survive independently

Colostrum

Breasts may begin releasing the thin yellow fluid, not breast milk

29 weeks

Mother can feel almost every movement and baby grows at a rapid rate.

32 weeks

Almost 4 pounds, lanugo falls off.

35 weeks

5 1/2 lbs, will put on 1/2 lb per week.

Lightening

Baby lowers into position, lessening pressure on lungs, increasing bladder.

Braxton-Hicks

contractions also occur, which are intermittent, relatively pains painless contractions of the uterus.

4% of American babies are born exactly on their

Due date

First stage of labor

Regular contractions begin, cervix thins out, and opens. Can last from 2 - 24 hours. First pregnancy typically 12-15 hours.

Early first stage

Contractions are 15-20 mins apart 45-60 secs long. Fairly easy stage

Late first stage

Cervix is fully dilated 2-3 inches. More frequent contractions.

Transition phase

Contractions are very strong. Final dilation of cervix 3-4 inches

Second Stage

Cervix is fully dilated. Baby’s head moves into vagina. Can last a few minutes - hours. Baby is pushed down vagina with each contraction.

Crowning

head appears at introitus.

An episiotomy

Is performed by doctors where perineum is slit to prevent being torn.

Shoulders move out of the vagina and child is born then:

The baby takes its first breath, umbilical cord is cut w placenta still in uterus.

Third stage

Placenta detaches from wall of uterus and it and fetal membranes are expelled. Can take several minutes to an hour.

How many births are by Cesarean section

One in five births.

An incision is made through abdomen and wall of uterus where the physician lifts out the baby and then sutures the uterus and abdomen.

Procedure of cesarean section:

Infertility

inability to conceive (or impregnate) after one year of regular intercourse without birth control. 40% - female problem 30% - male, 20% - both, 10% - unknown.

**Artificial Insemination**

process of introducing sperm into a woman’s reproductive tract without intercourse. Physicians often prescribe fertility drugs to increase chances that there will be healthy ova present.

In Vitro Fertilization

(test-tube babies): ova are put into petri dish and mixed with washed sperm and once fertilization has occurred, zygotes are transferred to a woman’s uterus. Most women have Fallopian tube blockage. Only 5% to 30% of zygotes implant in uterine wall.

Drugs and alcohol have been linked with \*blank\* causing low birth weight and mental delays.

Fetal alcohol syndrome (FAS)

Ectopic Pregnancies

zygote implants outside of uterus, 97% implanting in fallopian tube. Remaining 3% occur in abdomen, cervix, or ovaries. May cause rupture - internal hemorrhaging and possibly death.

Contraception for Ancient Greeks and Romans

sponges and the withdrawal (coitus interrupts)

Contraception for Ancient Egyptians

Douching with wine and garlic. Crocodile dung soaked in sour milk and stuffed up the vagina.

Contraception for 18th ct. Europe

animal intestine “condoms” appear. Invention of the “rubber” condom in 1840s.

The pill and cancer:

Pill protects against endometrial cancer and ovarian cancer. There are some reports of increased risk of breast cancer in women who are on the pill, but this is disputed. The pill may also aggravate already existing cancer.

Lunelle

Monthly injection of estrogen and progestin- has a fairly quick return to fertility once stopped.

Nuvaring

PER: 99.7%, TER: 92%. Thin patch placed on buttock, stomach, or upper torso for 3 weeks- sticks to skin and releases hormones into the bloodstream. May be less effective in women over 198lbs.

Progestin-only pills

PER: 99.7%, TER: 92% Inhibits ovulation, thickens cervical mucus, decreases cilia movement, and creates difficult egg implantation because of endometrial changes.

Depo Provera

PER: 99.7%, TER: 97% Synthetic progestin in suspension. Injected into the muscle every 13 weeks. Maintains female in luteal phase of cycle (anovulatory). Woman ceases to menstruate in most cases (sometimes after VERY irregular periods) and does not ovulate.

Norplant(1992-2002)/Implanon(2006)

PER: 99.7%, TER: 97%. Six rod shaped silicone capsules implanted usually inside upper arm. They steadily release progestins into the female for 5 years. Effects are same as other progestin contraceptives. Most effective method of contraception available, but also very expensive.

IUD (intrauterine device)

PER: 99.9%, TER: 99.2% A plastic device sometimes containing metal or a hormone that is inserted into the uterus. Prevents fertilization by producing changes in the uterus and fallopian tubes (Inflames the uterine lining and producing sperm or ova killing antibodies. Preventing endometrial cell growth). Sperm are immobilized - can’t move into fallopian tube- Extremely effective. Release progestins.

Sterilization for males and females

PER: 99.9%, TER: 99% 19% of women and 15% of men ages 15-50 have been sterilized; it’s the most common contraceptive method.

Vasectomies and tubal ligation

cutting and sealing of vas deferens and same thing but for fallopian tubes. 2-11% of women have surgical complicatons and potential slight increased risk of prostate cancer.

Essure

tiny, spring-like device threaded into Fallopian tubes where it creates tissue growth around device, blocking fertilization.

Plan B: Emergency contraceptive

progestin based - inhibits ovulation, thickens, cervical mucus, reduces endometrium

When is Plan B most effective?

when begun 12 to 24 hours after intercourse and cannot be delayed longer than 72 hours.

Which STIs are Ectoparasitic Infections

Pubic Lice and Scabies

Pubic Lice/Crabs

Attach themselves to base of pubic hairs (eyebrows, eyelashes, it must be sparse hair) and feed off blood of host. Only survive 30 days, 24 hours off a host but eggs can survive a week.

Incidence: Symptoms: Transmission: for Crabs

300/mil yr worldwide, no mandated reporting, found more often in adolescents. ; Itching most common symptom ; sexual contact, sheets, towels, sleeping bags, or toilet seats.

Diagnosis: Treatment: for Crabs

Identifying lice, rash ; Lindane solution (Kwell) and washing/drying infested fabrics

Scabies

caused by mite sarcoptes scabei spread from skin to skin contact during sexual and nonsexual contact. Live up to 48 hrs on sheets and clothing - impossible to see with naked eye.

Incidence ; Symptoms ; Transmission for Scabies

Millions - no mandated reporting ; Rash and intense itching, take longer to develop (4-6) weeks if a person has never been infected before ; Same as pubic lice

Diagnosis ; Treatment ; for Scabies

Visual inspection or scraping of rash ; Topical creams washing of bedding

Which STIs are Bacterial?

Gonorrhea, Chlamydia, Syphilis

Gonorrhea (‘the clap’ , ‘drip’) bacterium Neisseria gonorrhoeae:

Oldest of sexual diseases. Can cause urethritis, cervicitis, and PID. Increased chance of getting HIV. Can enter bloodstream and infect the heart or joints.

Incidence ; Symptoms ; for Gonorrhea

820,000/yr in US. 570,000 people 15-24 ; Appear 5-8 days after infection: Males: puslike discharge from meatus- the area may swell. ½ the men experience burning sensations during urination. Inflammation spreads to other parts of the genitalia. 60-80% of females are asymptomatic. Women who do have symptoms: cervix discharge, frequent urination, abnormal uterine bleeding, may develop PID.

Transmission ; Diagnosis ; Treatment for Gonorrhea

Sexual penetration (oral, vaginal, rectal) Can be passed to child during birth. Increases risk of HIV ; Testing secretions from infected area ; Antibiotics

Chlamydia

Most frequently reported disease in U.S.-highest among under 25.

Incidence ; Symptoms ; for Chlamydia

By 30, at least ½ sexually active women infected. Almost 1 million cases in US in 2004 ; 80% women, 25% men have very mild symptoms. 75% of women- No symptoms at all. Females: Burning during urination, pain during intercourse, pain in lower abdomen, cervical bleeding or spotting. Males: penile discharge, burning during urination, and pain/swelling in testicles. Can also have inflamed eyelids and oral infection.

Chlamydia is linked to increased:

Ectopic pregnancy, premature delivery, and low birth weight babies. 5x more likely to contract HIV if exposed.

Transmission ; Diagnosis ; Treatment for Chlamydia

contact with genital, oral, or rectal area of an infected person. Can be passed to child during birth ; Testing cells from infected area ; Antibiotics.

Syphilis: Spirochete treponema pallidum

Bacterium. Discovered by Pasteur in 1870.

Incidence ; Transmission ; Symptoms for Syphilis

55,400/yr US ; Contact with mucus membranes of infected genitals, mouth, anus, or through broken skin. Can be passed during pregnancy ; Begins 10-90 days after infection with a large painless sore/ lesion on genitals or in mouth called a chancre, then later a generalized body rash (also on palms and soles of feet), hair loss, swollen glands, fever, weight loss then (6 weeks) symptoms stop while it causes severe heart disease, muscle weakness, numbness, brain or liver damage, insanity or death.

Dementia caused by Syphilis

General paresis

Diagnosis ; Treatment ; for Syphilis

Blood test, tests of lesion material, symptom report. ; Penicillin (fails in some cases).

Trichomoniasis

form of vaginitis caused protozoan parasite.

Incidence ; Symptoms ; for Trichomoniasis

Most common curable STD. 3.7 million in US. ; Women: discharge or burning. Men: may be asymptomatic. 70% of infected people don’t have symptoms. Symptoms within 5-28 days or much later and can disappear ;

Transmission ; Diagnosis ; Treatment ; for Trichomoniasis

Test vaginal or penile discharge ; Oral medication Flagyl is most common.

Bacterial vaginosis (BV):

Most common cause of vaginal discharge/odor, but ½ are asymptomatic. Caused by overabundance of bacteria normally present in vagina.

Vulvovaginal candidiasis (yeast infections):

caused by fungus normally present but multiplies when pH is disrupted by antibiotics, douching, pregnancy, OCs, or diabetes. Symptoms: discharge, pain. Treatment: OTC drugs.

Pelvic inflammatory disease:

**Incidence:** 10% to 20% of women with gonorrhea or chlamydia will develop PID. 20% of women become infertile, 20% develop chronic pelvic pain, and 10% who conceive have ectopic pregnancy. 

**Symptoms:** can be asymptomatic. Acute pelvic pain, fever, abnormal vaginal discharge. 

**Treatment:** antibiotics for 14 days. 

Human papillomavirus: family of HPVs: Incidence ; Symptoms;

20 mil cases, 6 million NEW cases each year, 10,000 cancer cases, 3,700 deaths. 50-75% of sexually active people will become infected. ½ women exposed to it will contract it. Rarely passed to children ; Many are asymptomatic. "2/3 of people who have sex with a partner with HPV with warts will develop warts within 3 months. 10% of HPV lead to genital warts- cauliflower shaped warts appearing in the urethra, shaft, and scrotum of males; on the vulva or cervix of females.

Human papillomavirus: family of HPVs: Transmission ; Diagnosis ; Treatment

Touching warts. Types 16 and 18 cause 70% of cancer and are asymptomatic. Increases risk of cervical. penile, anal, and throat cancer. HPV is present in 90% of cervical cancer cases. 33,700 cancer cases every year ; Pap smear, warts ; Warts can be removed, by acid, laser, or freezing, but virus remains in body = no cure. Gardasil- vaccine to prevent cervical cancer caused by 4 types of HPV

Herpes virus: herpes simplex Type 1

Responsible for cold sores and fever blisters.

Herpes virus: herpes simplex Type 2

Genital herpes

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Herpes virus: herpes simplex 1 or 2: Incidence ; Symptoms

776,000 new in US/yr. 16% of people 14-49 yrs. have HSV-2. 90% is type 2, 10% is type 1 ; Within 2 weeks (usually a few days) of exposure. Majority are asymptomatic. Women= more severe symptoms. Initial "outbreak": sores- small, painful bumps or blisters (that burst) on the genitals, flu like symptoms, frequent painful urination.

Herpes virus: herpes simplex 1 or 2: Transmission ; Diagnosis ; Treatment

Genital/oral contact with active or prodromal (pre-active) sores. Can infect child during birth ; Visual inspection, test fluid, blood test ; There is no cure. Discomfort can be treated, further outbreaks may be lessened by acyclovir

Viral Hepatitis Type A

Cannot be sexually transmitted

Viral Hepatitis Type B transmission

Transmitted through high-risk sexual contact. 850,000-2.2 million people with chronic HBV infection

Viral Hepatitis Type B Symptoms

Mostly asymptomatic, but may include nausea, vomiting, jaundice, headache, fever, fatigue. 15-25% die from chronic liver disease. HBV has a vaccine.

Viral Hepatitis Type C Transmission

Can be spread through sexual behavior and caused most by sharing needles. 2.7-3.9 million people with chronic HCV infection.

Viral Hepatitis Type C Symptoms

asymptomatic or mild illness. 75-85% develop chronic liver infection. HCV does NOT have a vaccine.

Human Immunodeficiency Virus (HIV) Causes Acquired Immunodeficiency Syndrome: Incidence ; Symptoms

70 million people have had ___ , 35 million have died of AIDS. Globally, 34.0 million people had ___ in 2011 ;

Is a retrovirus- It reproduces only in the living cells of the host. The virus is copied along with the cells. It can also mutate very quickly. Targets white blood cells (T cells). Reproduces and destroys the T cells. Once the number of T cells are low, the person cannot fight off infection.

Human Immunodeficiency Virus (HIV) Causes Acquired Immunodeficiency Syndrome Transmission ; Diagnosis

Infected blood, semen, vaginal secretions or breast milk enters bloodstream: 1. Intercourse. 2. Contaminated blood. 3. Contaminated needles. 4. Pregnancy/childbirth. NOT transmitted by insect bites or urine, feces, saliva, tears, or nasal secretions, unless these are bloody ; Blood tests to identify antibodies

Human Immunodeficiency Virus (HIV) Causes Acquired Immunodeficiency Syndrome ; Women

(hetero) more likely to contract HIV than men- fastest growing group with AIDS. Spermicides can increase risk.

Human Immunodeficiency Virus (HIV): Prevention ; Treatment

Vaccines have not succeeded because HIV is a retrovirus (its generic construction mutates). PrEP is not a vaccine- PrEP must be taken consistently (DAILY)- PrEP in the bloodstream reduces risk of HDV from sex by more than 90%, from needles 70% ; Antiretroviral drugs such as AZT and ddI or ddC help slow immune breakdown.