Makindo Medical Notes

An episode of unprotected sex can pose risks for unintended pregnancy and sexually transmitted infections (STIs), including HIV. Below is a general plan often considered by healthcare professionals. Always consult a qualified healthcare provider for personalized medical advice.

1. Overview and Risk Assessment: Assess urgently

• Time Since Exposure: Many interventions (e.g., emergency contraception, HIV PEP) are time-sensitive.
• Partner’s Risk Factors: Consider if the partner has a known STI or is of unknown status.
• Menstrual and Sexual History (if relevant): Last menstrual period, contraception use, cycle regularity.

2. Emergency Contraception (EC) If there is a risk of unintended pregnancy

• Levonorgestrel (Plan B One-Step, etc.): Most effective if taken within 72 hours, can be used up to 120 hours.
• Ulipristal Acetate (Ella): Effective up to 120 hours (5 days). May be more effective than levonorgestrel late in the 5-day window.
• Copper IUD: Can be inserted within 5 days (120 hours). This is the most effective EC method and can provide ongoing contraception.

3. HIV Post-Exposure Prophylaxis (PEP) If there is a significant risk of HIV exposure

• If there is a significant risk of HIV exposure (e.g., unprotected sex with a partner of unknown or positive HIV status), a healthcare provider may recommend PEP.
• Initiation: Within 72 hours (3 days) of exposure, ideally as soon as possible.
• Duration: A 28-day course of antiretroviral therapy.
• Follow-up: Testing at baseline, 4–6 weeks, 3 months, and possibly 6 months.

4. Other STI Prevention and Follow-up as beyond HIV, other infections may be of concern

• Baseline Testing: Screen for STIs like chlamydia, gonorrhea, syphilis, and hepatitis.
• Empiric Treatment: Depending on risk assessment, some clinicians may treat for common bacterial STIs.
• Follow-up Testing: Repeat tests may be needed after the “window period” (e.g., 2 weeks for gonorrhea/chlamydia, 6 weeks+ for syphilis).
• Hepatitis B Vaccination Status: Check if the individual is vaccinated. Post-exposure prophylaxis for hepatitis B may be offered if unvaccinated.

5. Monitoring and Counseling

• Support and follow-up are essential. Healthcare providers typically advise:
• Symptoms Monitoring: Watch for any signs of STI (e.g., discharge, sores, pain, flu-like symptoms).
• Emotional Support: Provide counseling or mental health resources due to stress or anxiety after an exposure.
• Preventive Strategies: Education on safer sex practices, such as consistent condom use or pre-exposure prophylaxis (PrEP) for HIV.
• Long-Term Contraception Planning (if relevant): Consider a reliable contraceptive method to reduce future risk.