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Gynecological Problems and HIV/AIDS

July 2006

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HIV-Positive Women and Gynecological Problems

Certain gynecological (GYN) conditions are more common, more serious and/or more difficult to treat in HIV-positive women than HIV-negative women. If left untreated, some GYN infections can develop into more serious conditions such as pelvic inflammatory disease (PID) or cervical cancer.


Which GYN Conditions Are Most Problematic?

Herpes Simplex Virus (HSV, Genital Herpes)

There are many forms of herpes. The most common forms of herpes are herpes simplex virus-1 and herpes simplex virus-2. Although herpes-1 is most often associated with cold sores, both forms may be sexually transmitted and can cause genital herpes.

Like other viruses, herpes remains in your body for life. It hibernates in nerve roots when it's not causing symptoms such as painful blisters or open sores in the genital area. Herpes outbreaks can happen over and over again and may be linked to stress, fatigue, lack of sleep, menstruation, or genital friction.

HIV-positive women tend to have more frequent and more difficult-to-treat herpes breakouts than HIV-negative women. Studies have found that, in HIV-positive people who also have herpes, just treating HIV does not necessarily lessen the number or severity of herpes outbreaks. Herpes can be treated using antiviral drugs such as acyclovir (Zovirax™), valacyclovir (Valtrex™), and famciclovir (Famvir™).


Human Papillomavirus (HPV, Warts)

Human Papillomaviruses (HPVs) are the most common sexually-transmitted infection in the United States. The Centers for Disease Control and Prevention estimates that about 6.2 million Americans become infected with genital HPV every year. Studies suggest that over 50% of all sexually active men and women become infected with HPV at some time in their lives.

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One study found HPVs in 77 percent of HIV-positive women. Different types of HPV cause warts or abnormal cell growth (dysplasia) near the anus or cervix. More than 95% of cervical cancers have been shown to be associated with HPV types 16, 18, 31, 33, and 45. HPV may also cause cancer in the vagina, vulva, and anus.

In June, 2006, the Food and Drug Association (FDA) approved a vaccine called Gardasil™ for prevention of cervical cancer. The vaccine is approved for girls and women who are 9-26 years of age. Gardasil™ is effective in preventing cervical cancer caused by HPV types 16 and 18, which cause approximately 70% of all cervical cancers and in preventing infection with HPV types 6 and 11, which cause approximately 90% of all genital warts. Gardasil™ is a recombinant vaccine (contains no live virus) that is given as 3 injections over a 6-month period.

However, women who are already infected with HPV are not protected by the vaccine. Also, Gardasil™ does not protect against less common HPV types not included in the vaccine. Therefore, doctors still recommend regular Pap smears to detect changes in the cervix (dysplasia) before they become cancerous, so that women can receive treatment before cervical cancer develops. When dysplasia is detected and treated early, cervical cancer can be prevented.

Anal HPV is also very common among HIV-positive women. An anal Pap smear and physical examination are the best ways to detect anal dysplasia. It is important to ask your doctor to perform these tests on a regular basis.

Several treatments are available for HPV, but they generally do not cure the disease, and some have significant side effects. These treatments also tend to be expensive, so it is important that people who have HPV discuss the pros and cons of treatment with a doctor who is experienced in treating HPV in HIV-positive patients.


Fungal Infections (Yeast Infections, Vaginal Candidiasis, Vaginitis)

Candidiasis is a very common vaginal infection caused by yeast (fungus). Symptoms include itching, burning, and pain around your vagina, labia, or anal area. You may also have a thick, cottage cheese-like vaginal discharge. HIV-positive women often have recurring yeast infections that are difficult to treat. You are more likely to experience yeast-related problems if you:

  • Have low CD4 cell counts
  • Take antibiotics, steroids, or birth control pills
  • Douche, wear tight underwear, or use scented soaps
  • Use over-the-counter drugs frequently to treat yeast infections or don't finish the full course of treatment

Treatments include:

  • Over-the-counter creams like Monistat or Gyne-Lotrimin or prescription anti-fungal creams (HIV-positive women often need longer courses of treatment)
  • Prescription oral antifungal drugs such as Nizoral (ketoconazole), Diflucan (fluconazole), or Sporanox (itraconazole) for difficult-to-treat infections. Many antifungal drugs interact with HIV drugs. Some of them are also not recommended for pregnant women. Make sure your doctor knows what HIV drugs you are taking and whether you are pregnant or are trying to become pregnant.

Prevention of yeast infections. If you think you may be prone to vaginal fungal infections, there are some things you can do to help prevent them. First, you can drink milk that contains acidophilus or eat yogurt with active cultures. There are also over-the-counter acidophilus supplements you can take, but you should make sure you take one that has a high level of active cultures. Also, some foods or food ingredients can promote the growth of yeast. Nutritionists recommend that you avoid foods containing yeast, sugar, dairy foods, wheat, and caffeine. If you smoke or drink alcohol, you should be aware that alcohol and nicotine can also promote the growth of yeast.


Syphilis

Syphilis is a sexually transmitted infection caused by bacteria. The first symptoms of syphilis usually occur about three weeks after exposure. The first symptom is a hard, painless, red sore at the site of sexual contact. This sore usually disappears after 2-6 weeks. Within one week to six months after the sore heals, symptoms of secondary syphilis may occur. These symptoms include swollen lymph glands, a rash especially noticeable on the palms of the hands and soles of the feet, and painless sores on various parts of the body.

Having syphilis can make you more likely to transmit HIV if you are already HIV positive, and you are more likely to contract HIV from a partner who has both HIV and syphilis. Penicillin is the standard treatment for syphilis, but doxcycline or tetracycline can be given to patients who are allergic to penicillin.


Other Sexually Transmitted Infections

Other sexually transmitted infections commonly seen in HIV-positive women include chlamydia, gonorrhea, bacterial vaginosis, and trichomonas. Antibiotics are available to treat these conditions. Your doctor can diagnose these infections and prescribe effective treatment. It is important to treat these conditions, because having these infections may make it more likely that you will transmit HIV, if you are HIV positive already. In addition, chlamydia and gonnorhea can cause pelvic inflammatory disease.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
 
See Also
What Did You Expect While You Were Expecting?
HIV/AIDS Resource Center for Women
More on Gynecological Complications

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