“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

www.cdc.gov
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

www.cdc.gov
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

www.cdc.gov
 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
www.cdc.gov
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
www.cdc.gov
Chlamydia: Fertility in Men

• Epididymitis
• Infertility

www.cdc.gov
Chlamydia: Pregnancy

• Bacteria can infect an infant during vaginal

delivery
• Premature delivery
• Pneumonia
• Conjunctivitis (pink eye) in newborns

www.cdc.gov
Conjunctivitis in an Infant

Image found at emedicine.medscape.com

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
www.cdc.gov
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

www.cdc.gov
 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
www.cdc.gov
 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

www.cdc.gov
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 www.soc.ucsb.edu

www.cdc.gov
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
www.cdc.gov
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 pathmicro.med.sc.edu

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

www.cdc.gov
Syphilis Rash

Image found at www.lib.uiowa.edu

Syphilis: Symptoms
Late Stage:

 The nervous system is especially affected and will

eventually lead to death

www.cdc.gov
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

www.cdc.gov
Syphilis in Infants
Syphilis in Infants

Congenital Syphilis in
New York State:

2008: 23 cases

2009: 19 cases

Image found at www.adhb.govt.nz

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

www.cdc.gov
Syphilis: New York Statistics 2008

New York State: 6.3 cases per 100,000

7th highest Syphilis rate among US states
www.cdc.gov
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

www.cdc.gov
Herpes
Herpes: Transmission

 Skin or genital contact with an infected person

 Contact with a herpes sore

 Transmission can occur even without visible sores

www.cdc.gov
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

www.cdc.gov
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

www.cdc.gov
 Herpes in Infants

In 2009 in New York State, there were 13 cases of neonatal herpes, 4 deaths
nyc.gov/health

Image found at www.herpesdiagnosis.com

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

www.cdc.gov
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

www.cdc.gov
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 www.saddleback.edu

www.cdc.gov
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

www.cdc.gov
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)

www.cdc.gov
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

www.cdc.gov
 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

www.gardasil.com
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

www.cdc.gov
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

www.cdc.gov
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

www.cdc.gov
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

www.cdc.gov
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

www.cdc.gov
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: inspot.org
STI Prevention: inspot.org
 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@hotmail.com