Gynecologic Manifestations of HIV

Aka: Gynecologic Manifestations of HIV, HIV related Gynecologic Complications

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II. Associated Conditions: Invasive Cervical Cancer (AIDS defining disease)

  1. Progressive Immunodeficiency enhances HPV replication
    1. HPV infection is very common in HIV
    2. HPV Implicated in Cervical Cancer and anal carcinoma
  2. Monitor high risk patient with Pap Smear every 6 months
    1. Women with Cervical Dysplasia
    2. CD4 Cell Count <200

III. Associated Conditions: Infectious Vaginitis

  1. Vulvovaginal Candidiasis
    1. Occurs in 20-30% HIV infected women if CD4 Count >500
    2. Recurrent Candidiasis in young women suggests HIV
  2. Trichomonas
    1. Extremely prevalent
    2. Unrelated to CD4 Counts
    3. May be refractory to Metronidazole

IV. Prevention

  1. HPV Vaccine for appropriate age groups
  2. Cervical Cancer Screening
    1. HIV is associated with increased risk of HPV
    2. Obtain Pap Smear at initial HIV diagnoses
    3. Repeat Pap Smear yearly for at least 3 years
      1. If normal may repeat every 3 years
      2. Co-testing with Pap Smear AND HPV Testing may be performed after age 30 years
      3. Continue obtaining Pap Smears life long in HIV Infection

V. References

  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]

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