Contraception and abortion
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
Nexplanon® is a flexible rod, similar in size to a match stick (40 mm × 2 mm) and is inserted subdermally 8 cm above the medical epicondyle, usually of the non-dominant arm (Figure 6.4). Insertion is conducted under local anaesthesia using a specially designed insertion device. Nevertheless, poor insertion technique can still result in deep insertion with consequent difficult removal, so insertion should only be conducted by clinicians who have undertaken appropriate training. The implant is not usually visible, but should be easily palpable. Nexplanon® contains a small quantity of barium, which permits it to be visualized by X-ray. It can also be localized using low-frequency ultrasound probes, which can help aid removal of implants that are not easily palpable.
Contraceptive implants
John Guillebaud in Contraception Today, 2019
Nexplanon®, formerly known as Implanon, works primarily by ovulation inhibition, supplementing it is thought the usual sperm-blocking mucus effect caused by progestogens. Sustained low blood levels of the progestogen block LH surges while allowing some ovarian follicular activity. It is a single 40-mm rod, just 2 mm in diameter, containing 68 μg of etonogestrel – the chief active metabolite of desogestrel – and so has much in common with a well-taken DSG POP. This is dispersed in an EVA matrix and covered by a 0.06-mm rate-limiting EVA membrane. The rod now also contains barium sulfate, so it can be imaged by x-ray studies but it remains bio-equivalent to Implanon, with the same release rate and 3-year licensed duration of action.
Contraceptive implants
John Guillebaud in Contraception Today, 2016
Nexplanon, formerly known as Implanon, works primarily by ovulation inhibition, supplemented mainly by the usual sperm-blocking mucus effect. It is a single 40-mm rod, just 2 mm in diameter, containing 68 μg of etonogestrel – the chief active metabolite of desogestrel – and so has much in common with a well-taken DSG POP. This is dispersed in an EVA matrix and covered by a 0.06-mm rate-limiting EVA membrane. The rod now also contains barium sulphate, so it can be imaged by X-ray studies but it remains bio-equivalent to Implanon, with the same release rate and 3-year licensed duration of action.
Localized, on-demand, sustained drug delivery from biopolymer-based materials
Published in Expert Opinion on Drug Delivery, 2022
Junqi Wu, Sawnaz Shaidani, Sophia K. Theodossiou, Emily J. Hartzell, David L. Kaplan
Nearly 80% of women from high-income countries have reported using oral hormonal contraceptive pills [32]. These hormones include androgens, estrogens, and/or progesterone. Combination pills that include both estrogen and progestin are associated with breakthrough bleeding, a twofold risk of myocardial infraction and stroke and a 37 times higher risk of venous thrombosis [32,33]. Additionally, contraceptive pills must be taken daily, leading to decreased patient compliance and drug effectiveness if the user forgets to take or misplaces the pills. Subdermal implants that achieve sustained, long-term systemic release of contraceptives were created to address these issues [34]. Nexplanon is an etonogestrel-releasing ethylene vinylacetate copolymer rod-shaped implant inserted subdermally in the arm, and can be left in place for 3 years via surgical incision [35]. If the patient sustains injuries near the implant site, however, the implant could be damaged and may require surgical removal [36]. Additional side effects associated with systemic subdermal contraceptives include menstrual disturbances, acne, headache, abdominal pain, hair loss, weight gain, and follicular cysts [34]. Currently, the most popular local contraceptive delivery systems are intrauterine devices (IUDs), which are used by more than 168 million women worldwide. However, IUDs also have complications such as causing infections, pelvic inflammatory disease, uterine perforation, and menstrual disturbances [37,38].
Syphilis at age 15 years
Published in Baylor University Medical Center Proceedings, 2018
Jacqueline Kaufman, Bogar Garcia, Shawn Horrall
A 15-year-old female presented with worsening nonpruritic rash on her palms and soles for 1-month duration. She denied any fever, pain, pruritus, dysuria, vaginal discharge, or previous vaginal sores. In the past year, she had been treated in the emergency department for gonorrhea/chlamydia and then again for trichomonas. She reported a total of 8 sexual partners since the age of 14 with occasional use of barrier protection. She is on Nexplanon for birth control and is up-to-date on her vaccinations. On exam, the rash is limited to palms and soles as shown in (Figure 1). Her ocular exam revealed a weak pupillary reflex to light with normal accommodation. The remaining neurological exam was unremarkable, including proprioception and Romberg's test. Pelvic exam did not reveal any lesions, lymphadenopathy, or discharge. A venereal disease research laboratory test was positive and confirmed by positive Treponema pallidum antibody test. Penicillin G intravenous was initiated due to concern for neurosyphilis. Ophthalmology's ocular exam did not reveal ocular findings of syphilis. A lumbar puncture was performed and was negative for neurosyphilis. Intravenous penicillin was then changed to intramuscular. She was then discharged with improvement at her 4-week follow-up.
Current and future contraceptive options for women living with HIV
Published in Expert Opinion on Pharmacotherapy, 2018
Rena C. Patel, Elizabeth A. Bukusi, Jared M. Baeten
Among a cohort of Kenyan women using either etonogestrel or levonorgestrel implants, unadjusted pregnancy rates were 2.2 (95% CI 1.4–2.9) and 5.8 (95% CI 3.3–8.4) per 100 women-years in women concomitantly using nevirapine- and efavirenz-containing ART, respectively (adjusted pregnancy rate ratio of 3.0, 95% CI 1.3–4.6) [7]. In a retrospective study of women using levonorgestrel implants, 15 of the 121 women concomitantly using efavirenz became pregnant at a median duration of 16.4 months, while no pregnancies occurred among women concomitantly using nevirapine [48]. Therefore, both the PK and clinical evidence strongly suggests reduced contraceptive effectiveness, likely due to DDIs. However, in the same Kenyan cohort study, the use of alternative contraceptive methods other than permanent methods or IUC resulted in higher pregnancy rates when combined with efavirenz-containing ART; adjusted pregnancy rate ratios ranged from 1.6 for injectables to 2.8 for oral contraceptives when compared to implants [7]. Thus, despite the DDIs likely reducing the implant effectiveness, implants remained one of the most effective methods – and the most effective method readily available – to these Kenyan women. A similar analysis with data pooled from prospective trials from various parts of Africa concluded similar findings [49]. Currently, both the WHO and the US Centers for Disease Control and Prevention MEC recommend implant and efavirenz combination as a category 2 [12,50].