More on STI’s and Unplanned Pregnancy

1. More on STI’s and Unplanned Pregnancy

2. Warning Signs & Symptomsof an STI • Pain during sexual intercourse • Genital itching • Burning pain when urination/bowel movement • Sores, rashes, lumps, bumps, blisters • Discharge from penis & and vagina (may have an odour) • Pain/swelling of glands in groin • Deep abdominal pain

3. Types of STI’s • Syphilis - presence of sores in the mouth or the genital region. Sores last about five weeks generally heal by themselves. Fever, patchy hair loss, headaches, weight loss and swollen glands with no itch indicate the second stage. Paralysis, gradual blindness dementia and death are a possibility in the last stage of syphilis. The infection is treated with antibiotics. • Chlamydia- usually has no visible symptom. There is an abnormal discharge from the vagina and penis. It could also be accompanied with pain in the testicles and burning sensation during urination. Pelvic organ inflammation is also seen in women. Chlamydia has to be treated with oral antibiotics. • Genital Herpes: Type 1- HSV-1 causes cold sores and fever blisters in the mouth but can be spread to the genitals. • Type 2-HSV-2 usually occurs on the genitals bit can spread to the mouth. An outbreak of Herpes causes painful blisters to appear on the genital organs, buttocks or thighs. There is no cure. An antiviral drug can help the pain and itching and also reduce the frequency of frequent outbreaks. • Gonorrhea- pain or burning while urination. There may be a yellowish or sometimes, even a bloody discharge from the penis or vagina. A sexual intercourse may itself be painful. Gonorrhea is treated with oral antibiotics. • Chancroid- tiny swellings in the genital organs. These swellings gradually turn into ulcers and are usually painful. Often, there is an associated tenderness in the lymph nodes. Chancroid is treated with oral antibiotics. • Hepatitis B- mild fever, headaches, muscle aches and joint pain. It is also accompanied by loss of appetite, nausea and vomiting. Fortunately, there is hope that all future cases of the infection will be eliminated by routine immunizations of all children with the Hepatitis B vaccine

4. Bacterial Chlamydia An often-asymptomatic infection That can lead to reproductive complications What is it? • The most common bacterial sexually transmitted infection • Greatest number of infections found in people 15 to 24 years old • Can affect the cervix and urethra, and occasionally the rectum, throat, and eye How is chlamydia transmitted? • Chlamydia can be spred through unprotected oral, vaginal or anal sex with an infected partner • Penetration and ejaculation are not required for transmission • It can be passed from an infected mother to her infant during birth, causing lungand/or eye infections

5. Bacterial Gonorrhea An often-asymptomatic infection That can lead to reproductive complications What is it? • The second most common bacterial STI • Two-thirds of reported cases in Canada are in men • Most common in individuals 15 to 29 years • Can affect the cervix, urethra, rectum, throat, and occasionally the eyes • Often occurs as a co-infection with chlamydia How is gonorrhea transmitted? • Gonorrhea can be spread through unprotected oral, vaginal or anal sex with an infected partner • Penetration and ejaculation are not required for transmission. • It can be passed from an infected mother to her infant during birth, causing an eye infection.

6. Bacterial Syphilis A staged STI once considered rare in Canada, but now on the rise What is it? • An infection sometimes called the great imitator because symptoms mirror those of some common medical conditions • Progresses in stages • Infectious in the first year after contraction How is syphilis transmitted? • Through oral, vaginal or anal sex with an infected partner • Through direct contact with bacteria contained in syphilitic sores or rashes • In rare cases, from sharing unclean needles or receiving a blood transfusion • From an infected mother to her fetus, which can result in fetal death or congenital syphilis (causing birth defects)

7. Viral Genital Herpes A very common viral infection that can cause genital and anal sores What is it? • Herpes simplex virus (two types: HSV-1, traditionally associated with cold sores, and HSV-2, traditionally associated with anogenital herpes) • May cause a single outbreak or recurrences over time Recurrences may be triggered by: • The menstrual cycle in women • Emotional stress • Illness (especially fever) • Sexual intercourse • Surgery • Exposure to sun (including tanning beds) • Use of certain medications

8. Viral Hepatitis B A vaccine-preventable viral infection that affects the liver Hepatitis B: People with chronic hepatitis B are at risk of suffering progressive liver disease and liver cancer. What are the signs and symptoms? In up to 50% of people, there are no outward signs of infection. Up to eight weeks after exposure to the virus, some people experience flu-like symptoms including: • Tiredness • Nausea and vomiting • Decreased appetite • A rash • Joint pain • Yellowing of the eyes and skin (in rare cases)

9. HIV/AIDS Human Immunodeficiency Virus (HIV) Transmitted through the exchange of bodily fluids passed through mucous membranes or blood Acquired Immune Deficiency Syndrome (AIDS) Occurs when a person’s immune system has become so weak that it can no longer successfully fight off infection

10. HIV/AIDS What is it? Virus that destroys cells critical to a person’s immune system, robbing the body of its ability to fight other infections and illnesses. Weakens the immune system over time (months to years) until other infections occur and Acquired Immunodeficiency Syndrome or AIDS (the fatal stage of HIV infection) develops

11. HIV/AIDS How is HIV transmitted? When the body fluids of an infected person (blood, semen, pre-semen, vaginal secretions, breast milk) enter the blood stream of another individual—specifically, from: Unprotected vaginal, oral or anal sex Use of contaminated sex toys Shared needles or other drug equipment (i.e. water, cookers, crack pipes)

12. HIV/AIDS HIV-infected blood or blood products Household items such as toothbrushes and razors that have touched infected blood Transmission during pregnancy, childbirth or breastfeeding (transmission from mother to child) HIV cannot be transmitted by mosquitoes or other insects that have made contact with infected blood, nor can it be transmitted through saliva, sweat, tears, urine or feces of infected individuals, unless blood is present.

13. HIV/AIDS What are the signs and symptoms? Two to four weeks after exposure, some infected individuals may experience mild flu-like symptoms that last a few weeks then disappear. For most people, symptoms don’t emerge until years after exposure. Once the immune system is weakened, the following may develop: • Frequent fever or sweats • Joint or muscle pain • Persistent skin rashes • Swollen glands • Sore throat • Fatigue or lack of energy • Headaches • Rapid, unexplained weight loss • Nausea, vomiting, or diarrhea

14. HIV/AIDS A blood test to check for HIV antibodies is the only way to detect HIV infection. It may take up to three months for an infection to be detectable. Anyone at high risk who tests negative initially should retest three months later for certainty. HIV: An individual who is diagnosed with HIV requires regular medical consultation. HIV destroys cells critical to the immune system, leaving carriers susceptible to other infections.

15. HIV/AIDS In Canada, it is estimated that 27% of people with HIV do not know they are infected and risk transmitting the virus to others. Partner notification is important; infected individuals should seek guidance from their healthcare providers. 

16. HIV/AIDS What you need to know about HIV/AIDS: HIV can live in a person’s body for ten years or longer before any signs of it appear No sure way of knowing whether someone has contracted HIV without a blood test Initial symptoms can include fever, diarrhea, weight loss, dry cough, and swollen glands There is no cure

17. Testing/Screening Importance and Timing The early detection and treatment of STIs is critical to prevent further spread of infections Testing men: A penile exam using a swab to collecturethral discharge When to get tested • Individuals who suspect they may have contracted an STI should ask their health care provider for guidance about when to get tested. Recommendations vary by type of infection. • Regardless of symptoms, at-risk individuals should be screened regularly. • Visible symptoms should not be the only reason for testing, as many infections are asymptomatic. If symptoms are not present or a person is infectious before symptoms appear, the infection can be unknowingly passed on to others. • At the start of any new sexual relationship, it is a good idea for both partners to get assessed and screened for infections. • Suspicion or diagnosis of an STI should prompt testing for other STIs if not already done. Testing women: A pelvic exam using a speculum to take swabs from the cervix and vagina

18. Testing Methods Diagnosing Sexually Transmitted Infections Urine sample: For testing of certain STIs, a urine samplemay be requested. The main methods of testing/screening are: 1. Swab from the urethra, cervix, vagina, anus or throat 2. Urine test 3. Blood test Approaches differ by infection and gender, and vary across the country. Smear: Cervical and urethral samples may be used to prepare a smear for testing. Blood test: For testing of some STIs, a blood sample is required.

19. CONTRACEPTION Chapter 10

20. CONTRACEPTION THE VOLUNTARY THE VOLUNTARY PREVENTION OF PREGNANCY PREVENTION OF PREGNANCY

21. Methods of Contraception

22. Contraceptive Skin Patch • Ortho Evra is a hormonal birth control method whereby synthetic hormones are delivered directly through the skin and into the bloodstream via a thin patch. • Women can wear the Ortho Evra contraceptive patch on the buttocks, abdomen, upper torso (front and back, excluding the breasts), or upper outer arm.

23. Contraceptive Skin Patch • Ortho Evra is replaced on the same day of the week for three consecutive weeks, and the fourth week is "patch-free." • The patch remains attached and effective while exercising, bathing or in hot, humid conditions. • It contains the same synthetic hormones as combined oral contraceptive pills (estrogen and progestin) and is • thought to be about as effective as the Pill.

24. The NuvaRing vaginal contraceptive ring With NuvaRing®, estrogen and progestin release is activated once the ring comes into contact with the vagina. The hormones are then absorbed and distributed into the bloodstream. In a given 1-month period, NuvaRing® must be inserted into the vagina, removed after 3 weeks, and a new ring must be inserted no more than 7 days later.

25. Combined Oral Contraceptives • Come in different forms • Single hormone -- Progestin only • Combined hormone - progestin & estrogen • With Blanks or with lactose pills or ferrous sulfate so there are no blank days • Pill should be taken the same time each day • Extended-cycle COC- a 91 day regimen in which the woman takes a pill for 84 days followed by 7 days of menses.

26. Cautions in Use of Combined Oral Contraceptives • Contraindicated in woman with history of • Thrombophlebitis and thromboembolic disorders • Cerebrovascular or cardiovascular diseases • Estrogen-dependent cancer or breast cancer • Benign or malignant liver tumors • Hypertension • Migraines with focal aura • Diabetes with vascular involvement

27. Cautions in Use of Combined Oral Contraceptives • Contraindicated in woman with • Any of the above conditions • Impaired liver function • Suspected or known pregnancy • Undiagnosed vaginal bleeding • Heavy cigarette smoking • Major surgery requiring prolonged immobilization

28. Emergency Contraception Used after unprotected intercourse (condom breaks, rape, contraceptive not used correctly or did not use contraceptive).

29. Emergency Postcoital Contraception • Ovral Therapy - Two tablets taken 72 hours after unprotected intercourse and 2 tables taken 12 hours later. • Action: High levels of estrogen interfere with production of progesterone. Progesterone levels fall and therefore the endometrium will slough. • Preven (kit) available by prescription - estrogen and progestin. • Plan B – progestin-only method. Available OTC to women over 18 years old. • May insert IUD within 5 days Ovral

30. Mechanical Barriers

31. Mechanical BarriersIntrauterine devices IUD • Prevents implantation • Most common is copper T-shape • Patient must check placement after menses and before intercourse • Side Effects: PID, increase in bleeding and spotting, cramping, uterine perforation. Report pelvic pain.

32. Intrauterine Device (IUD) The Mirena Intrauterine System, which releases levonorgestrel gradually, may be left in place for up to 5 years

33. CondomMale and Female • Sheath to cover the penis in the male • Sheath inserted into the vagina and anchored around the cervix Prevent the transport of sperm to the ovum • Some should be used with a sperimicide • Teach how to apply and how to remove to be effective.

34. The Contraceptive Sponge moisten well with water and insert into the vagina with the concave portion positioned over the cervix. Should be left in place for 6 hours and may be worn for 24 hours

35. Diaphragm • Dome shaped rubber device with a flexible wire rim that covers the cervix. • May be used with gel or foam

36. Cervical Cap Similar to the diaphragm but smaller and may stay in for up to 48 hours.

37. Chemical Barriers Act as spermicides

38. Spermicides Foams Jellies CHEMICAL BARRIERS Suppositories Creams Gel

39. The only 100% effective method… from STI’s and un-planned pregnancy is Abstinence: not having sexual intercourse, or high risk sexual activities, and to abstain from any contact with infected people.

40. Unplanned Pregnancyhttp://www.statcan.gc.ca/kits-trousses/preg-gross/preg-gross-eng.htm • Children of teenagers are morelikely to have low birth weights, and to suffer the associated health problems.2 • Pregnant teens themselves are also at greater risk of health problems, including, for example, anemia, hypertension, renal disease, eclampsia and depressive disorders.3,4 • Teenagers who engage in unprotected sex are putting their own health at risk of sexually transmitted infections.1 • Teenage pregnancy also has economic consequences. Childbearing may curtail education and thereby reduce a young woman's employment prospects in a job market that requires ever higher levels of training.8,9 In addition, to maintain an adequate standard of living, dual earning is the norm in many Canadian households.10 But teenagers who give birth, particularly at ages 15 to 17, are likely to be single. Consequently, most teenage mothers lack a partner to contribute to the household income.3