Reproductive Health Care

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There are certain gynecological (GYN) conditions that occur more often in females that have HIV or AIDS. According to a recent report, 42% of women infected with HIV were also dealing with some form of GYN disease. Some of the more common conditions include chronic or repeated yeast infection (called candidiasis) and abnormal periods. Other conditions such as vaginal warts caused by Human Papillomavirus (or HPV), abnormal Pap smears, and pelvic inflammatory disease (or PID) are seen more frequently in sexually active females with HIV. Women and girls with a lowered CD4 count are more likely to develop a GYN condition and this condition may not respond easily to treatment. A discussion of each of these conditions is below, but the most important message from your health care provider is that good communication is of the utmost importance when dealing with such issues. Reporting any signs or symptoms that are worrisome or that don’t seem normal will help maintain your health. Ongoing GYN concerns will likely result in consultation with the adolescent specialist or gynecologist.

Yeast Infections

Vaginal candidiasis or yeast infection is the most common GYN condition known. As mentioned earlier, candidiasis can also occur in the mouth (oral) and/or in the esophagus or throat. All females have yeast in their bodies. When this yeast grows extensively, it can lead to a candidal infection. Several things that can cause this to occur include taking antibiotics, tight fitting pants, being overweight, diabetes, and poor hygiene. Symptoms of vaginal yeast infection include itching, burning with urination, burning or pain during sex, and/or having a white vaginal discharge. Frequent yeast infections may be the first symptoms of HIV. Babies and toddlers may develop candidiasis that first appears in the diaper area. It often looks like a raised red rash. This rash may be seen in older people too. This usually requires treatment with a prescription medication. The inside of the mouth should be examined as well. Often babies and toddlers who have candidiasis in their diaper area may also have it in their mouth.

Menstrual Changes

Women who have HIV or AIDS are more likely to have changes in their menstrual cycle or periods. This may be related to the disease itself or the antiretroviral medications. These women and girls may have periods that have a lighter or heavier flow. They may also have irregular periods or more frequent periods or may not have any periods at all. Any female who is having heavy bleeding, irregular bleeding, or painful periods should contact their health care team.

Sexually Transmitted Diseases

Genital herpes is a sexually transmitted disease. There are two types of herpes virus. Type 1 occurs most frequently in the mouth or on the lips and is often called a “cold sore”. Type 2 most often occurs in the vagina, around the penis, or in surrounding areas. It causes painful ulcers or sores. After the ulcers have healed, the virus remains in the body in a dormant or resting stage forever. People with the virus will have repeated outbreaks of painful sores from time to time. The frequency of these outbreaks is different for each person. In people that also have HIV, as the CD4 count drops, outbreaks may be much more frequent. Although there is not a cure for herpes infection, there is medication that can help decrease the number of painful days. Once a person has this virus, they can pass the virus to others even when the sores are not present. The infection occurs during skin to skin contact such as sexual intercourse or when kissing someone in an area where they have an open sore. Genital herpes can also be transmitted to a newborn baby from its mother at the time of delivery. If you have ever had genital herpes and are pregnant, it is very important to notify the health care team so appropriate medication and delivery methods can be investigated.

Genital warts are another virus that can be transmitted during sex. People who are HIV positive are at high risk for contracting genital warts. These warts look like small white or skin colored growths. Although there is treatment available, warts may be difficult to get rid of in an HIV positive person. Often, repeat treatments are needed. For females, the virus can also lead to an abnormal Pap smear due to a condition called cervical dysplasia. This condition occurs when the cells of the cervix change. These cells can progress to cancer if not found and treated. Females who are HIV+ are more likely to develop dysplasia and these changes may progress to cancer more quickly. There are no symptoms with early dysplasia, but vaginal discharge and bleeding may occur at a later stage of the disease. The Pap smear is the test that is used to diagnose cervical dysplasia and/or cervical cancer. Pap smear testing should be done as soon as an HIV positive female becomes sexually active. Any woman who is HIV positive and who develops genital warts or an abnormal Pap smear will need frequent follow-up testing.

Other sexually transmitted diseases include syphilis, pelvic inflammatory disease (or PID), chlamydia, gonorrhea, and trichimonas. Any vaginal discharge, burning with urination, abnormal bleeding with a period, lower belly pain, or any other unusual or worrisome symptoms should be reported to the health care team. Many of these STDs may not be associated with any symptoms. All sexually active HIV positive females and males may need to be routinely screened for these concerns.

Birth Control

If you are having sex or are planning on sexual intercourse, it is very important that you discuss this issue with your health care team. They will be able to give you information on birth control options. Antiretroviral medications frequently cause an interaction with birth control pills causing it to be less effective in preventing pregnancy. There is also the concern over safe sex practices to decrease the chances of giving HIV to a sexual partner. Information regarding safe sex practices is available from the health care team. A consultation with the adolescent specialist to address all these concerns should be done before sexual activities are initiated.

Pregnancy and Family Planning

Pregnancy can be very hard on the HIV positive female without good planning. While there are many issues to talk through before deciding to have a baby, one of the most important is to plan for continued good management of HIV during the pregnancy and to prevent transmission of the HIV to the newborn baby. This requires that CD4 counts and viral load be under very good control and that safe practices are used to become pregnant. Medications will be required to keep the baby from getting HIV. An obstetrician that is familiar with HIV will be necessary. Please ask the health care team for further discussion of family planning.

In the event of an unplanned pregnancy, please inform the health care team as soon as possible so that the health care needs, as well as emotional support, can be provided for the pregnant teenager and the unborn baby.

[Keywords:HIV]

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