Gynecological Care For Women With HIV

Introduction

Women with HIV have high rates of gynecologic disease. In research among one group of women with complications of HIV, about 83 percent were diagnosed with gynecologic conditions. Certain gynecological conditions are directly attributable to HIV co-infection and immune suppression. Thus, these conditions should be closely monitored to avoid any health hazards.

What Is HIV?

HIV (human immunodeficiency virus) is a virus that attacks the immune system (cells that help the body fight infection). This makes a person at more risk for infections and diseases. It is transmitted from one person to another by contact with certain bodily fluids of a person affected with HIV. It is commonly spread during unprotected sex or by sharing used injection drug equipment.

If HIV is not treated, it can lead to a disease called AIDS (acquired immunodeficiency syndrome). HIV has no effective treatment and cannot be cured because no vaccination has been found to date. Hence, once a person acquires HIV, they have it for life. However, antiretroviral therapy is available these days, which reduces the HIV amount in the blood (viral load). People with HIV infection who take proper care and prescribed medicine can live longer.

What Are the Various Gynecological Infections That Affect Women With HIV?

1) Human Papillomavirus Infection - Human papillomavirus (HPV) is a common sexually transmitted disease. About 75 percent of women who are sexually active acquire HPV. However, only a very few women with anogenital HPV infection get symptoms like genital warts. Most women many remain asymptomatic and develop precancerous lesions known as anal or cervical intraepithelial neoplasia. Two factors influencing the change of anogenital HPV from its asymptomatic stage to invasive cancer are the woman’s immune status and the HPV viral genotype (genetic construction of the virus).

Women with HIV are more prone to HPV than women without HIV. Also, women with HIV can not clear HPV (their body gets rid of the virus by itself) as HIV-negative women. Women with advanced HIV are more likely to develop dysplasia (abnormal cells on the opening of the womb) as a result of HPV. It is difficult to treat, and untreated dysplasia can cause cervical cancer. Detecting HPV in the early stage is important, and treating it with vaccination can also help eliminate complications.

2) Pelvic Inflammatory Diseases - Pelvic inflammatory disease (PID) is an upper genital tract infection. It happens due to a variety of sexually transmitted organisms, such as Chlamydia trachomatis and Neisseria gonorrhoea. It can lead to infertility and death. Women with chronic HIV infection can have an increased incidence of PID, which can increase the risk for immune suppression and sexually transmitted diseases. The symptoms of PID that are common in women with HIV include fever, pelvic mass, cervical friability, and cervical motion tenderness. Hospitalization with intravenous therapy is recommended, especially in cases of advanced immunosuppression. Few studies suggest oral antibiotic therapy was effective for HIV-positive women with PID.

3) Bacterial Vaginosis - Bacterial vaginosis (BV) is a condition caused due to the replacement of Lactobacillus flora with vaginal flora. There have been some claims that the lack of Lactobacillus organisms in BV contributes to the high risk for HIV transmission and acquisition. Treatment for symptomatic bacterial vaginosis is similar to that for HIV-negative women.

4) Genital Ulcer Disease - Genital ulcers are caused by a variety of systemic conditions, including Treponema pallidum (syphilis), herpes simplex virus (HSV), Haemophilus ducreyi (chancroid), cytomegalovirus, aphthous ulcers, infectious agents and drug reactions. Only herpes simplex virus (HSV) and aphthous ulcers increase among women infected with HIV. Severe and persistent HSV infections are common among men and women with seriously compromised immune systems and advanced HIV infection. The lesions are extremely painful and infectious. The viral shedding will be greater in advanced immunosuppression patients. The treatment for HSV is oral Acyclovir 400 mg three to five times a day. In severe cases, hospitalization for intravenous therapy is required.

5) Yeast Infections - Candida infections such as oral thrush, vulvovaginal candidiasis (VVC), and Candida esophagitis can occur due to immunosuppression induced by HIV infection. VVC is a common gynecologic condition in women. The prevalence of VVC is the same among HIV-negative and HIV-positive women, with immune systems remaining intact. The infection increases with declining CD4 cell counts. VVC is the main source of discomfort for many women with HIV infection. The symptoms of VVC are vaginal discharge, discomfort, and itching. The treatment of VVC in HIV-infected women includes a single oral dose of 150 mg of Fluconazole or topical intravaginal antifungal preparations.

What Are the Effects of HIV on Pregnant Women?

Women with HIV are able to become pregnant, and they need to discuss their plans with their doctors. The advances in HIV treatment have reduced the chances of vertical transmission (a mother will pass HIV to her child). If the mother takes appropriate care and medical precautions, the transmission rate can be reduced. Most HIV drugs are safe during pregnancy. Studies have proved that the fetus is healthier when the mother begins treatment for HIV before getting pregnant. Pregnant women with HIV can take similar HIV treatment as women who are not pregnant.

How Often Should Women With HIV Consult a Gynecologist?

It is very important for women with HIV to have routine gynecologist visits and tests for any abnormalities and cervical cancer.

• When a woman is first identified with HIV, a complete gynecological examination, with a cervical screening test and a pelvic exam, is required. The test should be followed after 12 months.

• If the results of three consecutive tests are normal, then a PAP (papanicolaou) test should be done every three years.

• If the PAP test result is abnormal, a repeat test in six to 12 months is recommended. Doctors may also suggest performing further tests like colposcopy.

• Co-testing with HPV test and Pap test is not recommended for women of age between 21 to 29.

What All Tests Should Women With HIV Carry Out?

The following tests should be carried out periodically for women with HIV.

• Breast Exam - The doctors will feel for any lumps or masses in both breasts. In women between 40 and 50, breast cancer screening with a mammogram is recommended.

• Pelvic Exam - The doctor will examine the outside of the genitalia for any sores, bumps, or other problems. Then using a speculum, the cervix (the opening to the uterus) is examined. The cells from the cervix are collected for the cervical cancer screening test to find any abnormal cells. The doctor may also collect fluid to check for infections.

• Bimanual Exam - No speculum is used for this examination. The doctors feel for the ovaries and uterus using their gloved fingers. A rectal examination may be carried out to check for any unusual bumps or sores. The stool sample is also collected to check for blood.

• Anal PAP Smear - This test is done for both males and females to check for abnormal cells (dysplasia) in the anus, which can lead to anal cancer.

Conclusion

Gynecological care is very essential primary for women with HIV. Regular appointments should be scheduled to monitor any variations in HIV diseases. Proper care and treatment at a prompt time will reduce the effect of symptoms from worsening, and the health of the patient can be maintained.