Makindo Medical Notes

⚠️ Emergency Contraception & Post-Exposure Care Unprotected sex poses risks of unintended pregnancy and sexually transmitted infections (STIs), including HIV. ⏱️ Rapid assessment is essential as many interventions are time-sensitive. Always seek advice from a qualified clinician.

1️⃣ Overview & Risk Assessment

• ⏰ Time Since Exposure: EC and HIV PEP are most effective when started early (≤72 hrs for most).
• 🧬 Partner’s Risk: Consider known HIV/STI status, risk factors, or high-prevalence setting.
• 🩸 Menstrual/Sexual History: LMP, cycle length, current contraception use, ovulation timing.

2️⃣ Emergency Contraception (EC)

• 💊 Levonorgestrel (LNG): Take within 72 hrs (some benefit up to 120 hrs). Less effective if BMI >26.
• 💊 Ulipristal Acetate (UPA, Ella): Works up to 120 hrs (5 days), maintains higher efficacy later in the window. Avoid if already on hormonal contraception (restart after 5 days).
• ⚙️ Copper IUD: Most effective method. Insert ≤5 days post-exposure. Provides ongoing contraception.

3️⃣ HIV Post-Exposure Prophylaxis (PEP)

• 💉 When? Start ASAP, ideally <72 hrs after exposure.
• 💊 What? 28 days of triple antiretroviral therapy (e.g., tenofovir + emtricitabine + raltegravir/dolutegravir).
• 🔍 Follow-up HIV testing: Baseline ➝ 4–6 wks ➝ 3 months ➝ 6 months (if high risk).
• 🤝 Adherence support is crucial to prevent failure.

4️⃣ Other STI Prevention

• 🧪 Screening: Chlamydia, gonorrhea, syphilis, HIV, hepatitis B/C as indicated.
• 💉 Hepatitis B: If unvaccinated, offer HBV vaccine ± immunoglobulin.
• 💊 Empiric treatment: Sometimes offered for gonorrhea/chlamydia after high-risk exposure.
• 🔄 Repeat testing: After window periods (2 wks for chlamydia/gonorrhea, 6 wks+ syphilis, 3 mo HIV).

5️⃣ Monitoring & Counseling

• 👀 Symptom vigilance: Look for discharge, ulcers, fever, pelvic pain.
• 🧠 Psychological support: Anxiety is common; counseling or crisis support may help.
• 🛡️ Future prevention: Condoms, reliable contraception, consider HIV PrEP for ongoing risk.
• 📆 Long-term contraception planning: Discuss IUDs, implant, or combined methods if pregnancy prevention is a priority.