oa SA Pharmaceutical Journal - Gynaecological care of the HIV patient : clinical

Volume 74, Issue 1
  • ISSN : 2221-5875
  • E-ISSN: 2220-1017



In the age group 15 - 24 years, women are 2.5 times more likely to be HIV infected.

Treatment principles for managing vulvovaginal candidiasis in HIV-positive women should be identical to those used in HIV-negative women.
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, , mycobacteria or cytomegalovirus infections.
Acyclovir-resistant HSV may be encountered in 11 - 17% of HIV-infected women and valacyclovir, famciclovir, foscarnet or cidofovir may need to be considered.
HIV-positive women with PID have higher temperatures, lower WB Ccounts, more syphilis, more bacterial vaginosis, less chlamydia, less abdominal tenderness and twice as much tubo-ovarian abscess formation compared with HIV-negative women.
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.
Colposcopic examination is warranted after a single pap smear shows cytological atypia, ascus, low-grade or high grade SIL or AGUS in an HIV-positive woman.
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.
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.
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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