Common GYN conditions
in women living with HIV/AIDS

Bacterial vaginosis
A bacterial infection of the vagina that can be sexually transmitted.

Symptoms

Many women experience no symptoms. If symptoms are present they can include, abnormal vaginal discharge (white or gray), unpleasant odor (can be a strong fish-like odor), burning when urinating, or itching around outside of vagina.

Diagnosis

A doctor will examine the vagina and may perform lab tests on a sample of vaginal fluid.

Treatment

Antibiotics that can include oral or topical applications of metronidazole (Flagyl) or clindamycin (Cleovin). Note: treat all sex partners.

Cervicitis
An inflammation of the cervix, caused by an infection such as a sexually transmitted infection or vaginal candidiasis or an allergic reaction to a birth control device, such as a diaprhragm or contraceptive spermicide.

Symptoms

Women may experience no symptoms. If symptoms are present they can include unusual vaginal discharge, abnormal vaginal bleeding, painful intercourse and pain when urinating.

Diagnosis

A pelvic exam or test for sexually transmitted disease, i.e. gonorrhea or chlamydia.

Treatment

Treatment will depend on the cause of the cervicitis. Once the cause is identified, treatment options can include antibiotics, over-the-counter creams or suppositories.

Chlamydia
A sexually transmitted infection that is caused by bacteria (Chlamydia trachomatis) and can affect a woman’s reproductive organs (cervix, uterus, ovaries and fallopian tubes).

Symptoms

Many women experience mild to no symptoms. If symptoms are present, they can include unusual vaginal discharge and burning when urinating. More advanced symptoms can include lower abdominal and back pain, nausea, fever, pain during intercourse, pain during sex; bleeding between periods and low-grade fever.

Diagnosis

Two kinds of laboratory tests are available. One test collects a sample from the infected site; the other test takes a urine sample and sends it to the lab.

Treatment

Treatments A doctor will prescribe antibiotics such as azithromycin (Zithromax), or doxycycline (Adoxa, Monodox, Vibramycin) taken orally. Alternative treatments include erythromycin, ofloxacin (Floxin) or levofloxacin (Quixin or Levaquin). Note: Treat sexual partners even if they have no symptoms. Avoid sex until treatment is completed. Avoid use of doxycycline, and ofloxacin during pregnancy.

Gonorrhea
A sexually transmitted disease caused by bacteria (Neisseria gonorrhoeae) that can affect a woman’s reproductive organs (cervix, uterus, ovaries and fallopian tubes), the anus, mouth and throat.

Symptoms

Women can experience mild to no symptoms. If symptoms are present, they can include unusual vaginal discharge and burning when urinating. Symptoms of an infection in the anus can include discharge, anal itching, soreness, bleeding and painful bowel movements.

Diagnosis

Two kinds of lab tests are available. One test collects a sample from the infected site; the other test takes a urine sample and sends it to the lab.

Treatment

Treatments Antibiotics, including ceftriaxone (Rocephin), ciprofloxacin (Cipro), ofloxacin (Floxin) or levofloxacin (Quixin or Levaquin). It is common to be co-infected with chlamydia. Alternative treatments may include an intramuscular injection spectinomycin (Trobicin)If chlamydia is not ruled out then a doctor may prescribe azithromycin or doxycycline (see treatments for chlamydia).

Herpes simplex virus
A sexually transmitted infection caused by herpes simplex virus (HSV). There are two virus types, II or I. Type II (genital herpes) is sexually transmitted and causes genital sores. Herpes Simplex I causes oral herpes, and is characterized by cold sores or fever blisters on the mouth or eyes.

Symptoms

Most women may experience mild to severe symptoms. If symptoms are present, they can include a burning or itching sensation, genital blister that break leaving tender ulcers (sores), pain in the legs, butt or genital area, abnormal discharge and lower abdominal pressure. These symptoms can last 2-4 weeks, when they first occur. However, the number of outbreaks and severity tends to decrease over time.

Diagnosis

Can sometimes be diagnosed by visual exam. Fluid from the sores should be taken to culture (try to grow in a laboratory) to confirm infection. Blood tests can also confirm infection, but not if infection is currently active.

Treatment

There are no treatments that can cure HSV II (genital herpes), however medications are available to shorten and prevent outbreaks. A doctor will prescribe antiviral medications including Acyclovir (Zovirax), Famciclovir (Famvir) or Valacyclovir (Valtrex). The dosage will depend on the number or episodes or outbreaks a person has had.

Human papillomavirus (HPV)
A sexually transmitted viral infection causes the abnormal growth of tissue in the forms of warts or dysplasia (change in the size, shape or appearance of cells). HPV can affect the cervix, vagina, vulva, urethra and/or anus.

Symptoms

Most women experience mild to no symptoms. If symptoms are present they can include multiple small warts (white spots) on the vagina or around the anus; vaginal discharge; or pain during intercourse.

Diagnosis

Can often be diagnosed visually, or with a Pap smear, colposcopy or biopsy.

Treatment

Depending on the severity, and the patient’s preference, options can include gels or chemicals applied to warts, cryotherapy, or electro-cautery (tissue destruction by electric current). Several types and multiple attempts of treatment may be necessary.

Molluscum
A non-cancerous skin growth caused by a viral infection and is transmitted by skin contact.

Symptoms

Small flesh colored or pink dome-shaped growths that can appear on the face, chest, abdomen, arms, groin or butt. They can become red or inflamed and can spread.

Diagnosis

Usually diagnosed by visual exam. Early biopsy is recommended for atypical lesions.

Treatment

Can include applying liquid nitrogen, electro-cautery (tissue destruction by electric current), topical application of cream, gel or antiviral medication, or surgical removal.

Pelvic inflammatory disease
A general term that refers to the infection of a woman’s internal reproductive organs (fallopian tubes, ovaries and uterus) and is often caused by untreated sexually transmitted infections, particularly chlamydia and gonorrhea. If left untreated it can lead to serious consequences including infertility, ectopic pregnancy, abscess and chronic pelvic pain.

Symptoms

Symptoms can vary from none to severe. If symptoms are present they can include lower abdominal pain, fever, unusual vaginal discharge, burning when urinating, painful intercourse, irregular menstrual bleeding.

Diagnosis

PID is difficult to diagnose and there are no tests specific for PID. A pelvic exam or pelvic ultrasound may be performed.

Treatment

A doctor will prescribe antibiotics. A combination of antibiotics can include cefotetan (Cefotan), cefoxitin (Mefoxin), doxycycline, clindamycin (Cleocin) and gentamicin (Amikin) and is either administered intravenously or orally. Depending on the severity of the infection, hospitalization may be recommended.

Period problems
Abnormal or changing menstrual cycles with a variety of possible causes including: chronic infection like HIV, use of street drugs (i.e. heroine), AIDS-related wasting, menopause, anemia, anti-HIV drugs or sexually transmitted infection.

Symptoms

Absence or suppression of menstruation (amenorrhea); irregular periods; bleeding between cycles; heavy or frequent bleeding (dysmenorrhea); or worsening of symptoms associated with PMS.

Diagnosis

If you have any of these symptoms, discuss them with your doctor.

Treatment

Treatment is dependent on the cause.

Syphilis
A sexually transmitted infection caused by bacteria (Treponema pallidum). Pregnant women can transmit syphilis to their baby.

Symptoms

Many women may experience mild to no symptoms for years. Sores can occur mainly on the external genitals, vagina, anus, or in the rectum. If un-treated, it progresses through 3 stages: primary (painless ulcers or lesions); secondary (widespread lesions and swollen (lymph glands); tertiary (advanced organ and tissue lesions).

Diagnosis

A doctor can use a micro-scope to examine the lesions, or conduct a blood test.

Treatment

Standard treatment for syphilis is an injection of Benzathine penicillin. For patients who are allergic to penicillin, doxcycline and tetracycline are prescribed.

Trichomonas (Trich)
A sexually transmitted infection caused by a protozoon (Trichomonas vaginalis).

Symptoms

Many women experience mild to no symptoms. If symptoms are present, they can include a frothy, yellow-green vaginal discharge with a strong odor, pain during intercourse and when urinating, irritation and itching around the vagina.

Diagnosis

A doctor will perform a pelvic exam and lab test on a sample of vaginal fluid.

Treatment

A doctor will prescribe metronidazole (Flagyl) taken orally. Note: treat all sex partners.

Vaginal candidiasis (yeast infection, vaginitis, candida)
Fungal infection of the vulva and vagina. Recurrent infections are the most common initial symptom of HIV infection in women and one of the most common complications experienced.

Symptoms

Itching with a thick vaginal discharge; burning upon urination; redness and white patches at the sites of infection; pain during sex.

Diagnosis

Usually first diagnosed by appearance and symptoms. If symptoms do not resolve after initial treatment, lab tests may be performed.

Treatment

Over-the-counter topical creams such as Clotrimazole (Gyne-Lotrimin cream); Miconazole (Monistat) or Butoconazole (Femstat cream). Some treatments such as Miconazole and Clotrimazole are also available by prescription as suppositories. If the yeast infection does not go away with the cream or suppository, a physician may prescribe a stronger drug such as ketoconazole (Nizoral) or fluconazole (Diflucan) tablets. For women who are pregnant, avoid using oral drugs or suppositories to treat yeast infections, as they can harm the fetus.