September 21, 2020 - Woodus Obstetrics and Gynecology | Dr. Tiffany Woodus

PrEP stands for pre-exposure prophylaxis. It’s a once daily medication intended to be taken prior to HIV exposure to help prevent infection. PrEP is recommended for anyone who is HIV negative, but is at high risk for infection. The brand name for the most commonly prescribed medication is Truvada and it consists of these two medications: Tenofovir and Entricitabine. Per the CDC, when taken daily PrEP can reduce your risk of HIV, infection from sex and by about 99% and from injection drug use by about 74%.

Now these medications are much less effective if not taken consistently. You will need an HIV test before you start taking PrEP and every three months, as long as you are taking it. Your doctor will also test your kidney function before prescribing Truvada and every six months, as long as you are taking the medication. You will need to be consistent about taking this medication daily. This medication does not prevent other STDs, so condoms are still needed.

All of the following place you in the high risk for HIV infection.

If you are a woman who is HIV negative with a partner who is positive for HIV or AIDS.
If you are sexually active in an area that has high numbers of HIV.
If you do not use condoms at all, or use them inconsistently.
If you have other STDs.
If you exchange sex for drugs, money, food, or shelter.
If you inject illegal drugs.
If you are dependent on alcohol.

Black people are by far the group most effected by HIV infection in the United States. Per the CDC, in 2018 we made up 13% of the population and 42% of all new HIV diagnoses. Black women are the group the hardest hit with an infection rate 15 times that of white women and five times that of Latino women.

What are possible side effects for PrEP?

Stomach pain, weight loss, headache, nausea, and diarrhea are the most common side effects. Now these symptoms typically go away spontaneously within a few weeks.

How expensive is PrEP?

PrEP can be expensive. Most insurance plans cover all or most of the medication. In some cases, cost assistance may be available.

Can PrEP be taken while you were trying to get pregnant?

Yes. We recommend that you start taking medication one month before you start trying to conceive and continuing it for one month after you have gotten pregnant.

Can PrEP be taken during pregnancy?

Most experts agree that it is safe to take, these medications are used to treat HIV positive women during pregnancy. There are no reports of birth defects caused by PrEP.

Can PrEP be taken while breastfeeding?

If you are HIV negative and high risk for HIV infection, PrEP can be taken while breastfeeding small amounts of the medications can be found in breast milk, but the amounts are so small it is unlikely to harm the baby.

Also remember to always use condoms.

The medical term for miscarriage is spontaneous abortion. It refers to early pregnancy loss in the first trimester, or during the first 13 weeks of pregnancy. Unfortunately, early pregnancy loss is common and is thought to affect 10% of known pregnancies. In reality, this number is even more common as some losses go unrecognized. You get into a situation where a woman just thinks that she had a weird period and doesn’t even recognize that she experienced a loss. Most early pregnancy losses are the result of a genetic issue. When mom and dad’s chromosomes link up, the body can detect that there may be an abnormality that is not compatible with growth and development, and the pregnancy may result in a loss.

Now, a lot of women wrestle with whether or not something they did or did not do caused or contributed to their loss. Put this out of your mind, don’t even entertain it. In most cases, neither you nor your partner had any responsibility in this. It is not something you could control or change.

Smoking, alcohol and caffeine have been studied as potential causes. The jury is still out in regards to smoking and alcohol. In other words, results are conflicting. At any rate, don’t do it. Moderate amounts of caffeine consumption, which is less than 200 milligrams per day, the equivalent of two cups of coffee per day, does not appear to increase risk.

The risk of early pregnancy loss does increase as we get older, particularly over the age of 40.

What do you typically experience with a pregnancy loss?

Bleeding and cramping are the most common symptoms. The cramping is similar to that experienced with a menstrual cycle, and the bleeding can be anywhere from spotting, to bleeding like a period, to even heavier bleeding. If you experience any of these symptoms, contact your healthcare provider.

Also keep in mind, you might experience spotting at various times throughout your pregnancy. The tissue is very sensitive in pregnancy. There’s a massive increase in blood flow to the area. Anytime something rubs up against the tissue of the cervix or the vaginal walls, such as intercourse, pelvic exams, or ultrasounds with the use of the vaginal probe, it can cause spotting.

How is early pregnancy loss typically diagnosed?

Typically by taking a history and performing a physical exam. An ultrasound may also be necessary. A blood test, measuring the pregnancy hormone or human chorionic gonadotropin, HCG, may also be necessary. The ultrasound and blood tests may need to be repeated for confirmation.

What are the options for early pregnancy loss?

Your physician will work with you to tailor your treatment plan specific to your situation. Options may include allowing the tissue to pass naturally. Medications may also be used to help expel the tissue. In some cases, surgery may be recommended. Your physician will review the specifics of each management plan with you in detail.

Another thing to keep in mind is if your blood type is RH negative, RH is rhesus factor, a protein found on your red blood cells, you may receive a shot of RH immunoglobulin. This is to help prevent future serious problems if the mother is RH negative and the fetus is RH positive.

What happens next?

We typically recommend pelvic rest, which means nothing in the vagina for a period of two weeks after a loss to help prevent infection. When should you be concerned? If you have a temperature with a fever of 100.4 or more, you have severe nausea, vomiting where nothing is staying down, everything you eat and drink is coming back up. If you experience severe pain that typical over the counter pain medications are not helping. If you have heavy bleeding where you are soaking, flooding your pad, having to change it every hour because it is soaked, saturated, and this goes on for more than an hour, seek medical care.

If you find that you are having trouble coping with your loss, talk to your provider, be open and honest about your feelings. Seeking counseling services, grief support groups, and spiritual support may also be helpful. Please know that most women can and will go on to have healthy, successful pregnancies. Recurrent pregnancy loss is rare. If you wish to try again, we recommend waiting until after your next normal cycle. If you do not desire pregnancy, we recommend starting a reliable form of contraception.