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n CME : Your SA Journal of CPD - Gynaecological care of the HIV patient : main article

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Abstract

In the age group 15 - 24 years, women are 2.5 times more likely to be HIV infected. <BR>Treatment principles for managing vulvovaginal candidiasis in HIV-positive women should be identical to those used in HIV-negative women. <BR>Approximately 50% of genital ulcers in HIV-infected women will be idiopathic and are called aphthous ulcers, while the rest are most commonly due to herpes simplex virus, mixed bacteria, syphilis, <I>Haemophilus ducrei</I>, mycobacteria or cytomegalovirus infections. <BR>Acyclovir-resistant HSV may be encountered in 11 - 17% of HIV-infected women and valacyclovir, famciclovir, foscarnet or cidofovir may need to be considered. <BR>HIV-positive women with PID have higher temperatures, lower WBC counts, more syphilis, more bacterial vaginosis, less chlamydia, less abdominal tenderness and twice as much tubo-ovarian abscess formation compared with HIV-negative women. <BR>Severe immunosuppression and high viral load significantly increase the likelihood of HPV infections, abnormal smears and SIL, and overall, HIV-infected women have a 5-6-fold increase of developing SIL. <BR>Colposcopic examination is warranted after a single Pap smear shows cytological atypia, ascus, low-grade or highgrade SIL or AGUS in an HIV-positive woman. <BR>Even though ablative or excisional procedures are the treatment of choice for CIN 2 or 3, the need for second or third therapeutic procedures is often required. Hysterectomy is not advocated as there is a 50% rate of recurrence at the vaginal vault. <BR>Menstrual disorders in HIV-infected women may not be directly due to the HIV, but to various factors that are not directly related to the disease. <BR>Condoms are the mainstay of contraception and should be encouraged either as the sole contraceptive or in addition to any other form of contraceptive method used.

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/content/m_cme/24/11/EJC63073
2006-11-01
2016-12-05
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