Information::Gynecological Programs

Gynecological Problems

By Shari Margolese

HIV+ Women and Gynecological Problems

Certain gynecological (GYN) conditions are more common, more serious and/or more difficult to treat in HIV+ women than HIV- 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, and genital friction.

HIV+ women tend to have more frequent and more difficult-to-treat herpes breakouts than HIV- women.

Human Papilloma Virus (HPV, warts)

Human papilloma viruses (HPVs) are common sexually-transmitted viruses. One study found HPVs in 77 percent of HIV+ women. Different HPVs cause warts or abnormal cell growth (dysplasia) near the anus or cervix.

Dysplasia is more common in HIV+ women, especially in women with advanced HIV disease. It is often more severe and difficult to treat than in HIV- women. Untreated dysplasia can lead to cervical cancer, a life-threatening illness. HPV may also cause cancer in the vagina, vulva, and anus.

Dysplasia can be detected by Pap smears. A Pap smear is a screening test your doctor does to check for changes in the cervix. An abnormal Pap smear can indicate inflammation, infection, dysplasia, or cancer. When dysplasia is detected and treated early, cervical cancer can be prevented.

HIV+ women are 10 times more likely to have abnormal Pap smears than HIV- women. These abnormal Paps are usually associated with low CD4 cell counts and HPV. It is very important for HIV+ women to have regular Pap smears.

Anal HPV is also very common among HIV+ women. An anal Pap smear and physical examination are the best ways to detect anal dysplasia. Access to Pap tests to detect anal HPV for HIV+ women are very limited. In Canada, they are currently only available through a few pilot projects in major cities.

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, curd-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.
Use over-the-counter drugs frequently to treat yeast infections or don't finish the full course of treatment.

Treatments include:

Acidophilus (in supplements or yogurt).
Creams like Monistat or Gyne-Lotrimin or prescription anti-fungal creams. (HIV+ women often need longer courses of treatment.)
For difficult-to-treat infections, there are prescription oral antifungal drugs such as Nizoral (ketoconazole), Diflucan (fluconazole), or Sporanox (itraconazole). Many anti-fungal drugs interact with HIV drugs. Make sure you check with your doctor before taking them.

Pelvic inflammatory disease (PID)

PID refers to inflammation in the upper genital tract. (The genital tract includes your vagina, cervix, 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.

The most common symptoms of PID are lower abdominal pain, irregular menstrual cycles, non-menstrual bleeding, vaginal discharge, and painful or frequent urinating. HIV+ women who develop PID should be followed closely with early hospitalization and IV therapy with antibiotics.

Menstrual (Period) Problems

Although there is little conclusive research regarding HIV+ women and menstruation, many HIV+ women report menstrual irregularities or worse premenstrual syndrome (PMS). Some women have excessive bleeding while others stop menstruating altogether (amenorrhea). If you have any of these symptoms, seek medical attention to determine the cause.

If you have menstrual problems your doctor may prescribe birth control pills to help regulate your cycles. Birth control pills interact with many HIV drugs. Some interactions can cause the pill to stop working and increase your risk for pregnancy. Others can cause decreased levels of HIV drugs and put you at risk for viral rebound and drug resistance. It is important to discuss drug interactions with your doctor before taking birth control pills or any other hormones.

Regular GYN exams and Pap smears are crucial to your health since many GYN conditions do not have obvious symptoms and can get worse without your realizing it. Detection and treatment in the early stages can prevent a GYN condition from progressing.

Reprinted and modified with the permission of The Well Project (www.thewellproject.com)
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