Gynecological Problems

The gynecological problems that women with HIV infection get are the same that all women get. But certain problems are more common or more severe in women with HIV infection: vaginal yeast infections, gen­ital herpes (discussed above), and cervical cancer.

Cervical Cancer

Cervical cancer, which has no symptoms in the early stages, is a concern in women with HIV infection, although the risk is increased only slightly over those without HIV. Cervical cancer is associated with infection by a virus called the human papillomavirus, or HPV. HPV also causes warts in the genital region. But the HPV that causes genital warts—easily seen as fleshy growths—and the HPV that is associated with cervical cancer are different strains of HPV; the HPV that causes visible warts does not cause cancer, and vice versa. Cervical cancer is detected by Pap smears. Pap smears turn out to have abnormal results more frequently in women with HIV infection than in those without. As a result, it is now recom­mended that women with HIV infection have Pap smears at their initial medical evaluation, then six months later, then every year thereafter. Those with abnormal Pap smears should have a referral to a gynecolo­gist.

Vaginal Discharge, Severe Genital Itching

A discharge that often resembles cottage cheese and severe genital itch­ing are symptoms of vaginal yeast infections. A yeast infection is a com­plication caused by the same fungus, Candida albicans, that causes thrush.

Vaginal yeast infections are common in all women: 50 percent of all women without HIV infection have vaginal yeast infections at some time. In women with HIV infection, vaginal yeast infections are more frequent, more severe, and less likely to clear up with treatment. Yeast infections occur at a relatively early stage of HIV infection, often when the CD4 cell count is over 500; but they become more severe and harder to treat when the CD4 count is low. In addition, women with low CD4 counts often need to take antibiotics, like Bactrim, for other complica­tions, but these antibiotics make vaginal yeast infections more common and more severe.

The usual treatment is a cream applied locally to the vagina, like Gyne-Lotrimin. These creams are available at drugstores without pre­scription. Women with more advanced stages of HIV infection are likely to find that local creams do not work very well, or that the yeast infec­tion may recur rapidly when treatments are discontinued. Management of this problem will often require consulting a gynecologist who might prescribe such drugs as fluconazole or itraconazole by mouth.

Vaginal Discharge, Pelvic Pain,

Painful Sexual Intercourse

Vaginal discharge, pelvic pain, and painful sexual intercourse are symp­toms of pelvic inflammatory disease, or PID. PID is an infection of the upper part of the genital tract: the uterus, fallopian tubes, and ovaries. The usual causes are sexually transmitted microbes like gonococcus and chlamydia. In its later stages, PID can lead to infertility, high rates of ectopic pregnancies, and chronic abdominal pain. PID may occur in women who do not have HIV infection as well as in those who do, but women with HIV infection appear to have PID more frequently, and in them it is more difficult to treat successfully. The diagnosis and treat­ment require evaluation by a physician, including a pelvic examination and prescription drugs. The standard drugs, antibiotics, are highly ef­fective in the short run but may not prevent the infertility and pain of the later stages of PID. Because of this, many physicians recommend that women with HIV infection and PID be hospitalized for treatment of PID.