Caring for a Woman's Body: What Every HIV-Positive Woman Should Know About the Care and Prevention of GYN Problems

Common GYN Problems

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

Sexually Transmitted Diseases (STDs)

STDs are infections and diseases that are passed from person to person through oral, vaginal, or anal sex. While there are over 25 STDs, the most common ones are listed here and described in more detail in the STD info sheet:

• Chlamydia
• Gonorrhea
• Genital warts/human papillomavirus (HPV; for more information specifically on HPV, see our HPV info sheet)
• Hepatitis (Hepatitis A, or HAV; Hepatitis B, or HBV; Hepatitis C, or HCV)
• Herpes simplex virus (HSV; genital herpes)
• Human immunodeficiency virus (HIV)
• Syphilis
• Trichomoniasis

Fungal Infections (Yeast Infections, Vaginal Candidiasis, Vaginitis)

Candidiasis is a very common vaginal infection caused by yeast (fungus). This fungus normally exists in the human body (including in the vagina) and lives in balance with helpful bacteria. When an imbalance occurs and the yeast overgrows, candidiasis occurs. Symptoms include itching, burning, and pain around your vagina, vaginal lips, or anal area. You may also have a thick, cottage cheese-like vaginal discharge. HIV+ 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
• Do not finish the full course of yeast infection treatments, whether those treatments are prescription or over-the-counter

Treatments include:

• Over-the-counter creams like Monistat or Gyne-Lotrimin or prescription anti-fungal creams (HIV+ women often need longer courses of treatment). Make sure you choose something that says it is for curing vaginal yeast infections and is not only for helping with vaginal itching.
• 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 health care provider 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 likely to get 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 bacterial cultures. There are also over-the-counter acidophilus supplements you can take, but it is important to 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, wheat, and caffeine. If you smoke or drink alcohol, you should be aware that alcohol and nicotine can also promote the growth of yeast. If you douche, you may consider limiting the frequency of douching or eliminating douching altogether. Douching reduces levels of helpful bacteria in the vagina and is not recommended for HIV+ women. Lastly, because yeast grows best in moist areas, wearing looser-fitting pants or underwear can help prevent yeast infections. Cotton underwear breathes better than underwear made of polyester or nylon, and can also help minimize yeast growth.

Pelvic Inflammatory Disease (PID)

PID refers to inflammation in the upper genital, or female reproductive tract (which includes your ovaries, uterus, and fallopian tubes.) PID is often caused by a number of common infections, including the sexually transmitted diseases (STDs) gonorrhea and chlamydia. PID starts after these infections travel up from the vagina to other organs in the body, where they can cause serious damage and lead to infertility.

The most common symptoms of PID are lower belly pain, irregular menstrual cycles, vaginal bleeding when you are not having your period, vaginal discharge, and painful or frequent urinating. HIV+ women who develop PID should be carefully followed by their health care providers since they may need to be hospitalized and treated with antibiotics.

Menstrual (Period) Problems

Many HIV+ women experience menstrual changes or irregularities. These changes to your menstrual cycle (or period) are less common if you have a high CD4 count and are taking HIV drugs. For more information on the types of menstrual changes HIV+ women experience and the effects of HIV and HIV drugs on women's periods, see our Menstrual Changes info sheet.

Menopause

Menopause usually occurs in women from 38 to 58 years of age because of natural changes in the body, including the ovaries making less estrogen. Symptoms of menopause include irregular periods (different in amount, frequency, or duration), hot flashes, and vaginal dryness.

Some studies have suggested that women with HIV may experience menopause earlier than HIV-negative women. This may be due to one or more of many factors including anemia, decreased hormone production, illness, weight loss, effects of HIV drugs, effects of street drugs, or smoking.

For more information about menopause, its symptoms, and options for relieving those symptoms, see the Menopause info sheet.