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Gynecological infection

Condition Overview:

Most women experience occasional gynecological infections. Women with HIV experience more of these infections, and when they do the infections tend to be more serious and less responsive to treatment. Indeed, gynecological infections are the most frequently reported health problems in women who are living with HIV. Some of these infections -- vaginal candidiasis, or "yeast" infection, for example -- generally cause only minor discomfort and usually respond promptly to over-the-counter medications. Other infections -- pelvic inflammatory disease, or PID, for instance -- can cause symptoms so severe that the patient must be hospitalized. Recurrence is common with gynecological infections, and those repeat infections tend to respond less well to therapy. Indeed, women who experience several episodes of PID often develop chronic pain, and the scarring that results from these flare-ups can lead to tubal infertility.
Because all of these gynecological conditions pose particular risks for HIV-positive women, it is especially important that women with HIV -- and their regular care providers -- be especially vigilant about vaginal health. Recognizing the early signs and symptoms of the most common gynecological infections seen in women with HIV can help those women obtain treatment early -- when the infection is most responsive to therapy and the likelihood of lasting damage is smallest.

This vigilance is required at all stages of HIV infection, but it is particularly needed during the later stages of infection, when profound immune suppression leaves patients susceptible to a host of AIDS-related opportunistic infections. Women with advanced HIV disease do develop PCP, CMV retinitis, MAC, and all of the other OIs that are commonly seen in AIDS patients, but in addition they are susceptible to the infections listed on the table that appears on the next two pages.

This special Pull Out and Save feature, "Common Gynecological Infections in Women with HIV," identifies the signs and symptoms of these infections, describes how they are diagnosed and treated, offers alternative therapies, alerts care providers to potential problems that can occur when these treatments are administered, and suggests ways that providers and patients can work together to reduce the likelihood of recurrent infections. The box at the bottom of this page lists several organizations that specialize in providing treatment-update information to women who are living with HIV.

All infections, including those listed in the table, are caused by one or more pathogens, or disease-causing agents. It is important to know what kind of pathogen -- viral, bacterial, fungal, or protozoal -- is causing a particular infection, because the choice of treatment is based on that information. It is possible to cure infections caused by bacteria, funguses, and protozoa. Viral infections such as herpes zoster infection can never be cured, but medication can clear up the symptoms and suppress viral activity, thereby reducing the likelihood of subsequent outbreaks.

As its name suggests, "Common Gynecological Infections in Women with HIV" covers only frequently seen vaginal infections in HIV-positive women. (It does not list the three most widespread sexually transmitted diseases -- syphilis, gonorrhea, and chlamydia -- even though these diseases can have gynecological manifestations, because these STDs are common in men as well as women. These STDs will be the subject of a future feature article in AIDS Care.) This special Pull Out and Save section offers readers another weapon in the ongoing battle against HIV infection and its manifestations. Familiarize yourself with the signs and symptoms of these common gynecological infections -- so that you can get early, effective help if you develop vaginal disease.