“But it was just once!
NO SURPRISES:
Sexual Health Planning
Heather Jordan, MPH
November 14th, 2010
STIs, Pregnancy and Planning
Good Preconception Health includes:
Making a Reproductive Life Plan
Making a plan for avoiding STIs
Making choices that are right for YOU
Reproductive Life Plan
Making a reproductive life plan is an important
part of preconception health
If you don’t want children now, what are you doing
to avoid pregnancy?
Abstinence? Oral Contraception? Condoms?
If you want children in the future, what are your
goals for becoming a parent?
Reproductive Life Plan
Because 50% of Pregnancies are Unplanned
STIs and Pregnancy
STIs can interfere with your plans for parenthood.
According to the CDC, STIs during pregnancy can be
responsible for:
Early labor
Low birth weight
Eye and respiratory infections
Stillbirth
[Link]
STIs
There are three ways of having sex that can put
you at risk for an STI:
• Vaginal Sex*
• Anal Sex
• Oral Sex
Bacterial Infections
Chlamydia
Gonorrhea
Syphilis
Bacterial infections can easily be treated and cured
with antibiotics.
Testing is an important part of preconception health
[Link]
Chlamydia…
…it’s not a flower.
Chlamydia: Transmission
Semen and vaginal fluids
Bacteria can infect an infant during vaginal
delivery
Teenage girls are especially at risk when the
cervix is not fully mature
[Link]
Chlamydia: Symptoms
Called a “silent disease” as most people present no symptoms
and do not know they are infected
Women: Men:
•Vaginal discharge •Discharge from penis
•Burning urination •Burning urination
•Pain during sex •Burning, itching,
swelling, pain in penis and
testicles
*Symptoms may also appear in mouth or rectum after oral or anal sex with an infected person
[Link]
Chlamydia: Symptoms
Infected Cervix
Normal Cervix
Chlamydia: Symptoms
Chlamydia: Fertility in Women
If left untreated, Chlamydia can lead to:
•Pelvic Inflammatory Disease (PID)
•Ectopic pregnancy
• Infertility
[Link]
Chlamydia: Fertility in Men
• Epididymitis
• Infertility
[Link]
Chlamydia: Pregnancy
• Bacteria can infect an infant during vaginal
delivery
• Premature delivery
• Pneumonia
• Conjunctivitis (pink eye) in newborns
[Link]
Conjunctivitis in an Infant
Image found at [Link]
Chlamydia: New York Statistics 2008
New York State: 458 cases per 100,000
10th highest Chlamydia rate among US states
New York City Area: 426.8 cases per 100,000
[Link]
Gonorrhea
I don’t want your ….
Gonorrhea: Transmission
Contact with the genitals, mouth or anus of an
infected person
Bacteria can infect an infant during vaginal
delivery
[Link]
Gonorrhea: Symptoms
Like Chlamydia, Gonorrhea is called a “silent disease” as most people
present no symptoms and do not know they are infected.
Women Men
•Painful/burning urination •Painful/burning urination
•Vaginal discharge •White, yellow or green discharge
•Vaginal bleeding from penis
•Often mistaken for a bladder or •Painful/swollen testicles
vaginal infection
* Symptoms may also appear in mouth or rectum after oral or anal sex with an infected person
[Link]
Gonorrheal Discharge
In a Woman In a Man
But remember: symptoms are not always this obvious and you cannot
tell if someone has an STI just by looking!
Gonorrhea: Fertility
Like Chlamydia, if left untreated
Gonorrhea can lead to:
Pelvic Inflammatory Disease (PID)
Epididymitis
Infertility
[Link]
Gonorrhea: Pregnancy
Affects in Infants:
Bacteria can infect an infant during vaginal delivery
Can cause:
Blindness
Infections of the joints and blood
– can be life-threatening to a newborn
Image found at [Link]
[Link]
Gonorrhea: New York Statistics 2008
New York State: 89 cases per 100,000
23rd highest Gonorrhea rate among US states
New York City Area: 80.3 cases per 100,000
[Link]
Syphilis
Syphilis: Transmission
Direct contact with a syphilis chancre or rash
Syphilis can pass through the placenta and infect
the unborn fetus
Syphilis: Symptoms
If syphilis is left untreated, it will pass through three
stages:
Primary Stage:
10-90 days after exposure a chancre will appear
near the site of contact
Usually firm, round, painless – can go unnoticed
Extremely contagious
Syphilis Chancre in a Man
Syphilis Chancre in a Woman
Image found at [Link]
Syphilis: Symptoms
Secondary Stage:
After the chancre heals, a skin rash and mucus
membrane lesions will develop
Symptoms will resolve themselves without
treatment – but the infection will persist
[Link]
Syphilis Rash
Image found at [Link]
Syphilis: Symptoms
Late Stage:
The nervous system is especially affected and will
eventually lead to death
[Link]
Syphilis: Pregnancy
Syphilis can pass through the placenta and
infect the unborn fetus
Seizures, brain damage, developmental delays
High risk of stillbirth or death shortly after
birth
[Link]
Syphilis in Infants
Syphilis in Infants
Congenital Syphilis in
New York State:
2008: 23 cases
2009: 19 cases
Image found at [Link]
Syphilis: Detection and Treatment
Detection:
Blood test
Because of the high risk of infant death, all
pregnant women should be tested for syphilis
Treatment:
Antibiotics can cure syphilis - but they cannot
undo any damage already done to the body
[Link]
Syphilis: New York Statistics 2008
New York State: 6.3 cases per 100,000
7th highest Syphilis rate among US states
[Link]
New York City Area: 7.2 cases per 100,000
Viral Infections
Herpes
Hepatitis B,C
HPV (Human Papillomavirus)
HIV (Human Immunodeficiency Virus)
• There are no cures for these viral infections
• Vaccines are available for Hepatitis B and HPV
• There is treatment available, but you must know you are
infected – ask your doctor about a test
[Link]
Herpes
Herpes: Transmission
Skin or genital contact with an infected person
Contact with a herpes sore
Transmission can occur even without visible sores
[Link]
Herpes: Symptoms
Sores or lesions may appear within two weeks after
exposure and go away 2 to 4 weeks later
Sores can be painful and can cause psychological
distress for those infected
Sores can go unnoticed or never appear at all
[Link]
Herpes: Symptoms
You can get herpes anywhere on your body
Herpes: Pregnancy
Infant more likely to contract herpes if the mother has an
outbreak at the time of delivery
If the mother has an outbreak, a cesarean delivery can avoid
infection in the infant
Complications from herpes can result in:
• Developmental delays
• Bleeding disorders
• Stomach and lung diseases
• Death
[Link]
Herpes in Infants
In 2009 in New York State, there were 13 cases of neonatal herpes, 4 deaths
[Link]/health
Image found at [Link]
Hepatitis A, B, C
Hepatitis A, B, C Transmission
Hepatitis: a group a viruses that cause
inflammation to the liver
Hepatitis A: spread by fecal contamination
There are vaccines against Hepatitis A and B, but
not Hepatitis C
There is no cure
[Link]
Hepatitis B, C Transmission
Spread through sex with an infected person
Contact with infected blood, including through
unsterilized tattoo, piercing and acupuncture
needles
Infants can be born with hepatitis
[Link]
Hepatitis B,C: Symptoms
Jaundice
Fatigue
Abdominal pain
Nausea, vomiting
Inflammation of the liver
Cirrhosis
There is no cure for Hepatitis B or C
Image found at [Link]
[Link]
Hepatitis B: Pregnancy
Infant can be infected in utero or during delivery
Infection can cause liver damage and health problems later in the
child’s life
Treatment within 12 hours of birth can prevent chronic infection
in infants
Hepatitis B vertical transmission is more common than Hepatitis
C
[Link]
HPV (Human Papillomavirus)
The Most Common STI in America
50 % of all sexually active adults
will have HPV at some point in their lives
HPV: Symptoms
Symptoms
Over 40 strains of HPV, various symptoms
Genital warts (1 percent of U.S. population)
Cervical cancer (10,000 women every year)
RRP (Recurrent Respiratory Papillomatosis)
[Link]
HPV: Detection and Treatment
Detection:
Women: Annual Pap smear
Men: There is no test for HPV in men
Treatment:
There is no cure for HPV
Warts can be removed or can disappear on their own
Cervical cancer is treatable if detected early
[Link]
HPV: Gardasil Vaccine
The Guardasil Vaccine can prevent
strains of HPV that cause cervical
cancer and warts.
The vaccine works best if you get it
before you start having sex.
Guardasil is now available for
girls and boys
[Link]
HIV (Human Immunodeficiency Virus)
HIV and AIDS: What’s the difference?
HIV stands for Human Immunodeficiency Virus
and is the virus that causes AIDS
AIDS stands for Acquired Immune Deficiency
Syndrome
AIDS is the late stage of an HIV infection, when
cd4 count has dropped below 200
Someone can have HIV for many years before
being diagnosed with AIDS
[Link]
HIV: Transmission
HIV is spread through:
• Semen
• Vaginal Fluids
• Blood
• Breast Milk
*Other STIs greatly increase your susceptibility to HIV!
HIV: Transmission
HIV is not spread through:
• Saliva
• Kissing
• Hugs
• Mosquitoes
• Public Toilets
HIV: Symptoms
The only way to know if you are infected is to be
tested for HIV infection.
You cannot rely on symptoms to know whether or
not you are infected.
HIV: Pregnancy
HIV can cross the placenta during pregnancy
HIV can infect an infant during delivery
HIV can be transmitted through breast milk –
breastfeeding is not recommended for HIV positive
mothers
[Link]
HIV: Pregnancy
Mother-to-child transmission can be reduced from
30% to 2% with medical interventions:
• The mother should be on antiretroviral treatment
• Cesarean delivery can reduce the infant’s exposure
to HIV
• All pregnant women should be tested for HIV
early to allow time to plan for such interventions
[Link]
HIV: Detection and Treatment
Detection
• Blood test
• Oral swab
Treatment
• There is no cure for HIV
• Antiretroviral treatment is available, which can
greatly improve life expectancy and quality of life
[Link]
STI Prevention
How can I protect myself from STIs?
ABC
STI Prevention
Abstinence
• Not having sex is the only 100% way to avoid
STIs and pregnancy
• Prolonging sexual debut can reduce risk for
STIs
• You don’t have to be sexually active to make a
reproductive plan, make one before you start!
STI Prevention
But it is not reasonable to expect people to
remain abstinent their entire lives
Remember:
• Oral and anal sex are still sex
• “Almost” having sex without protection can still
put you at risk for STIs like HPV and herpes,
which only require skin-to-skin contact
STI Prevention
Be faithful
• Be in an exclusive, monogamous
relationship
• Get tested, as a couple, before you have
sex
• If you’re not in an exclusive relationship,
use a condom every time
STI Prevention
Condoms
Condoms are highly effective in preventing
the sexual transmission of HIV
Can reduce the risk of other STDs
85 – 98% effective against pregnancy
Must be used consistently and correctly
[Link]
STI Prevention
How to use a Condom:
• Check the expiration date
• Put the condom on before any genital contact occurs
• Use enough lubrication
Never:
• Use two condoms at once
• Re-use a condom
The Female Condom
STI and Pregnancy Prevention
You can combine the ABCs to find a plan that
fits your life.
In what ways can your Reproductive Life Plan
overlap with your STI Prevention Plan?
In what ways should your Reproductive Plans
and STI Plans remain separate?
Prevention
What will not protect me from STIs?
Contraceptives like:
• Birth control pills
• Diaphragms
• Spermicidal gels
• IUDs
will help avoid pregnancy
but offer no protection against STIs.
STI and Pregnancy Prevention
Remember:
B is not for birth control
Abstinence, Condoms and Contraception can help
you avoid pregnancy
Abstinence, Being Faithful and Condoms can help
you avoid STIs
STI Prevention
If you find out you have an STI, you should
• Tell your current partner to get tested
• Tell your past partners to get tested
STI Prevention: [Link]
STI Prevention: [Link]
STIs and Pregnancy
Make a Reproductive Life Plan that fits your life
Get tested before you get pregnant
Get tested again early in your pregnancy
A Healthy Baby Begins with You.
Heather Jordan
heatherleila@[Link]
