News Highlights
ARTICLE FOR HEALTH PROFESSIONALS
CDC recommends health-care professionals change treatment of Gonorrhea
The rate of quinolone-resistant gonorrhea has been rising over the past few years. Initially, the populations mainly affected were men who have sex with men (MSM) and infections occurring in California and Hawaii. This past year showed a large increase in the rate of resistant gonorrhea in the heterosexual male population, rising from 0.6% to 7%.
Traditionally, the first line antibiotics were quinolones, which included ciprofloxacin. This was convenient because the medication was easily available and could be taken in one dose. Now, the recommendation is to switch to cephalosporins. The two recommended medications are ceftriaxone 125 mg IM (a one-dose injection) or cefixime 400 mg orally (one dose).
Although less common than Chlamydia in Canada, gonorrheal infection is equally concerning because of possible long-term side-effects. There are often no symptoms associated with the actual infection, it can lead to infertility in both men and women, and having gonorrhea increases the chance of acquiring the AIDS virus. Infection with Chlamydia or gonorrhea may attract HIV-infected cells to the skin surface in people infected with HIV, making it more likely to transmit it to a partner. In people who have gonorrhea but are HIV-negative, more CD-4 cells (the cells that HIV infects) are drawn to the skin surface than people without gonorrhea, making it easier for HIV to infect their cells.
Why are some women bleeding after six months of Mirena use?
Irregular bleeding or spotting is a common side-effect in the first 3-4 months after the IUS is inserted and usually decreases over time. However, some women who have had the IUS in for more than six months without any problems may suddenly start to bleed. It is uncertain why this happens or what is the best way to manage the issue.
Researchers in Sweden recently examined 30 women with Mirena IUS to find the causes of this late onset bleeding. Women who developed unscheduled bleeding after longer-term use were likely to have intrauterine polyps and fibroids, or a misplaced Mirena IUS. By replacing the IUS, the majority of women’s symptoms improved to the point where they felt comfortable with continued use of the contraceptive, although one patient had the second IUS removed because the bleeding continued.
The study’s outcome indicates that common causes of bleeding such as pregnancy, infection and cervical lesion, should be ruled out, and hysteroscopy should be performed while the IUS is still in place to diagnose the presence of an intrauterine polyp or mass, and confirm the proper location of the device before the IUS is removed or replaced.
Ronnerdag M, Odlind V. Late bleeding problems with the levonorgestrel-releasing intrauterine system: evaluation of the endometrial cavity. Contraception. 2007 Apr;75(4):268-70
New study drug compared to Plan B for emergency contraception
There are currently three forms of emergency contraception (EC) which include the Yuzpe method, Plan B (levonorgestrel only), and the intra-uterine device (IUD). Plan B and the Yuzpe method can be taken up to five days after unprotected intercourse but they are more effective the sooner they are taken. The copper IUD on the other hand can be inserted in the uterus as an emergency contraceptive up to one week after engaging in unprotected intercourse.
A Pittsburgh-based research group examined a new progesterone drug for use as an emergency contraceptive. The second generation trial drug, CDB-2914, was compared to Plan B. In this study, 775 women received one dose of CDB-2914 and one placebo pill 12 hours later. Another group of 774 women received Plan B, comprised of two doses of 750 mcg levonorgestrel administered 12 hours apart. Overall, there were seven pregnancies in the study group (85% effectiveness), and 13 pregnancies in the Plan B group (69% effectiveness). This is not considered a significant statistical difference. The most common side effects were fatigue and nausea, with nausea occurring slightly more in the group trying the new drug. Both groups also had differences in menstrual cycle length after taking EC, a normal side-effect of emergency contraception.
Creinin MD, Schlaff W, Archer DF, Wan L, Frezieres R, Thomas M, Rosenberg M, Higgins J. Progesterone receptor modulator for emergency contraception: a randomized controlled trial. Obstet Gynecol. 2006 Nov;108(5):1089-97
Ask Sexualityandu
What are the odds of getting pregnant if you only use the pill, assuming you've never forgotten to take it?
Birth control effectiveness is measured in a Pearl Index. Basically, this index estimates the number of pregnancies that will occur in one year, for every 100 women who are using this birth control method. If the birth control pill is used perfectly, for every 100 women who take the pill, 1-2 women will become pregnant each year. However, since most women do not take the pill perfectly, the actual-use failure rate is about 2-4 women who become pregnant each year.
Can stress influence irregularity of a menstrual cycle?
Yes, stress can definitely affect the timing of menstrual cycles. Some women can miss several months in a row with extreme stresses (like relationship breakup, loss of a loved one, school exams, etc). Physical stress can also cause skipped periods. Physical stress may include exercising for several hours every day, losing or gaining more than 10 lbs in a short period of time, or not getting enough calories to support the nutritional needs of both herself and a potential baby.
I heard that the birth control pill can make acne worse. Is that true?
No. In fact, all birth control pills have the potential to make acne better by lowering the amount of male hormones circulating in your blood. Certain birth control pills may be preferred for women with severe acne or for those who do not have a good response to another birth control pill. Be sure and ask your doctor if you have concerns with your acne. By the way, birth control pills do not cause weight gain, either.
