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Contraceptive Technology Conference!

Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding

Perimenopause

Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm

Ambivalence

Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception

Contraceptivetechnology.com New and Improved

Biologic sexism of STIs
September 2021

 

On any given day, 1 in 5 people has a sexually transmitted infection.[1] It is not unlikely that one of the infected will be seeing you for treatment. Most RTIs exhibit a “biological sexism,” say Jeanne Marrazzo and Ina Park.[2] Women are more likely than men to acquire RTIs, due to the transmission dynamics during an act of vaginal intercourse. For example, the risk of acquiring gonorrhea from a single act of vaginal intercourse (where one partner is infectious) is approximately 25% for men and 50% for women. The risk of acquisition increases when trauma occurs to the genital mucosa, as may be the case in sexual assault. For similar reasons, the risk increases from anal intercourse (a risk that also affects men who receive anal penetration). RTI acquisition is less likely during oral sex, digital penetration, or sex acts other than vaginal or anal intercourse.

Compared with men, women suffer more severe long-term consequences, including PID, infertility, ectopic pregnancy, chronic pelvic pain, and cervical cancer. Women may also be less likely to seek health care for assessment of RTI-related symptoms, because a higher proportion of their RTIs are asymptomatic or unrecognized as being serious. The probability of suffering consequences from an RTI, say Marrazzo and Park, depends on whether or not a patient receives proper diagnosis and treatment.

The probability that unprotected sexual intercourse will lead to RTIs or their consequences differs from the probability of unintended pregnancy. (See Table.) The risk of pregnancy varies according to the menstrual cycle. In contrast, while numerous complex factors probably modulate susceptibility to RTI:[1],[2]

  • having sex with an infected person
  • the gender of the infected person
  • transmissibility of the particular RTI
  • use of barriers or other protective measures

In the case of HIV, the quantity of serum (and presumably genital) HIV viral load directly influences risk of transmitting HIV to vulnerable partners. HIV viral load is extremely high in the context of early infection (the first several months after a person acquires the virus). Because sexual transmission of HIV frequently occurs during this early infection interval,[3] persons at risk need to consider HIV-prevention methods at all times.

Comparative risk of adverse consequences from vaginal or anal intercourse: RTI and unintended pregnancy

Unintended pregnancy (per coital act)[4]
  • 17%–30% midcycle
  • < 1% during menses
HIV transmission (per coital act)
  • 0.08% receptive vaginal sex
  • 0.04% insertive vaginal sex
  • 1.3% receptive anal sex
  • 0.11% insertive anal sex
Gonococcal transmission (per coital act)[5]
  • 50% receptive vaginal sex
  • 25% insertive vaginal sex
PID per woman infected with cervical chlamydia[6]
  • 22% if not treated
  • 0% if promptly and adequately treated
Tubal infertility per PID episode[7]
  • 8% after first episode
  • 20% after second episode
  • 40% after third or more episodes

Different individuals accept different levels of risk. Not everyone will follow every safer sex recommendation but, with the proper knowledge, each person can make his or her own informed choices about reducing risk. Some prevention messages are universal and should be reinforced (for example, barrier methods when appropriate). Additionally, client-centered counseling highlights the need to individualize risk assessment and tailor risk-reduction plans. The latter may include a discussion on selecting sex partners and building skills for negotiating safer sex.

Be sure to make your guidance specific to related to an individual’s particular issues, rather than giving vague, global advice, Marrazzo and Park inform us:

  • “Starting today, put condoms on the night stand beside the bed,” rather than “always use condoms.”
  • “You could reconsider whether to date this person, who is also dating other people,” rather than “Have fewer, safer partners.”
  • “Next time you’re out with friends and might have sex, avoid getting high on drugs or alcohol,” rather than “Have safer sex.”

Now stop for a minute as you reach the end of this article. Accept that your patients, and in many cases, you, the health care clinician, may have some reservation or feelings of awkwardness over holding these kinds of conversations. As Ina Park states in her book Strange Bedfellows: Adventures in the science history and surprising secrets of STDs, “…even with the ubiquity of STIs…most people (even health care providers) simply don’t feel comfortable discussing them. For most of us, having sex is much easier than talking about sex, especially its least pleasant consequences.”[8]

So how do you, we, go about discussing these sensitive and private topics? Park writes, “I don’t know, but we must start somewhere. We’ve managed to defeat stigma surrounding previously taboo subjects such as cancer, creating discourse and shifting public sentiment toward support rather than shame. We need similar sea change around STIs to have any hope of curbing the current epidemic.”

We must start somewhere, as Park says. Let’s start here.

[1] https://www.cdc.gov/std/statistics/prevalence-2020-at-a-glance.htm

[2] Marrazzo JM, Park IU. Reproductive tract infections,including HIV and other sexually transmitted infections.

[1] Cates W, Jr. Review of non-hormonal contraception (condoms, intrauterine devices, nonoxynol-9 and combos) on HIV acquisition. J Acq Imm Def 2005;38 Suppl 1:S8–10.

[2] Garnett G. The transmission dynamics of sexually transmitted infections. In: Holmes KK, Sparling PF, Stamm WE, et al., eds. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill; 2008:27–39.

[3] Pilcher CD, Tien HC, Eron JJ, Jr., et al. Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis 2004;189:1785–92.

[4] Trussell J, Kost K. Contraceptive failure in the United States: a critical review of the literature. Stud Fam Plann 1987;18:237–83.

[5] Garnett G. The transmission dynamics of sexually transmitted infections. In: Holmes KK, Sparling PF, Stamm WE, et al., eds. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill; 2008:27–39.

[6] Herzog SA, Heijne JC, Althaus CL, Low N. Describing the progression from Chlamydia trachomatis and Neisseria gonorrhoeae to pelvic inflammatory disease: systematic review of mathematical modeling studies. Sex Transm Dis 2012;39:628–37.

[7] Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992;19:185–92.

[8] Park I. Strange Bedfellows: Adventures in the science history and surprising secrets of STDs. New York: Flatiron Books, 2021, p. 5.