Human Immunodeficiency Virus Infection & Women

Vaginal infections are the most commonly reported condition among women with HIV/AIDS. Vaginal yeast infections are the most common initial manifestation of HIV/AIDS in women.

Many types of vaginal infections are twice as common in women who have HIV than in women who are HIV-negative. The risk for cervical cancer is 30 times greater for HIV-infected women who are also infected with HPV. Fortunately, most vaginal infections and related complications can be detected through regular Pap smears. Pap tests involve collecting a small tissue sample from the cervix that is examined under a microscope for an infection or abnormality.

Although there is some controversy about how often HIV-infected women should receive Pap smears, it is generally recommended that they have them every 6 months. If a Pap smear is abnormal, it should be repeated in 3 months. Without regular Pap smears, many vaginal infections go unnoticed until they become serious. In one study, half of HIV-infected women with no symptoms did actually have a vaginal infection. Regular Pap smears are essential.

Some physicians recommend that HIV-positive women also receive an annual colposcopy examination, which involves using a lighted microscope to view the cervix and look for pre-cancerous abnormalities.

Women who have HIV and experience vaginal irritation, unusual sensitivity, itching, or discharge should see a physician or other health care provider immediately. Treatment can relieve irritation, prevent the spread of sexually transmitted infections, and help prevent serious illnesses (e.g., pelvic inflammatory disease [PID]).

Vaginal Yeast Infections: Vaginal Candidiasis & HIV

Any woman, whether she has HIV or not, can develop a vaginal yeast infection. However, women who are HIV-positive are prone to more frequent yeast infections that are much more difficult to treat.

Yeast infections cause the following symptoms:

  • Vulval itching
  • Thick white vaginal discharge
  • Burning during urination
  • Vaginal dryness and redness
  • Painful vaginal intercourse (Women should avoid intercourse when they have a yeast infection.)

There are a number of ways to treat vaginal yeast infections, including topical creams such as miconazole (MonistatĀ®) and pills such as fluconazole (DiflucanĀ®).

Human Papillomavirus (HPV) & HIV

Human papillomavirus (HPV) is a viral infection that causes damage to cells in the genitals, especially the cervix. There are many different types of HPV, some of which can cause cervical cancer or pre-cancerous lesions on the cervix. In one study, women infected with HIV were 10 times more likely to have HPV than HIV-negative women, especially if their CD4+ count was below 500 cells/mL. In another study, 77 percent of HIV-positive women were also infected with HPV.

HPV is a fairly common vaginal infection among women who have HIV. It should be treated as soon as possible to prevent it from spreading and from developing into a serious condition. HIV-infected women who also have HPV are 30 times more likely to develop cervical cancer.

HPV is usually asymptomatic, but it may cause small, white warts or spots on the vagina or around the anus. Symptoms also may include some vaginal discharge and, rarely, painful intercourse.

Physicians usually diagnose HPV by doing a Pap smear, colposcopy, or biopsy, which involves examining infectious tissue under a microscope for the presence of pre-cancerous or cancerous abnormalities. There are several ways to treat HPV. The warts can be removed by burning, freezing, or cutting, or by treating them with a chemical or medication.

Pelvic Inflammatory Disease (PID) & HIV

Pelvic inflammatory disease (PID) is a very serious condition that can result from untreated vaginal or cervical infections. If left untreated, bacteria can spread from the vagina or cervix, through the uterus and fallopian tubes, and into the ovaries and surrounding tissues. PID causes serious damage to the reproductive tract and can be fatal. Chlamydia and gonorrhea are the most common causes of PID.

Pelvic inflammatory disease often leads to scarring in the fallopian tubes, which blocks them and prevents fertilization. Indeed, PID is a major cause for infertility in women of reproductive age. Even if fertilization occurs, the scarring is likely to interfere with the fertilized egg's passage to the uterus. If this occurs and the egg remains embedded in the fallopian tube, an ectoptic (also known as tubal) pregnancy results. Ectopic pregnancy can result in the loss of the fetus and is the major cause for pregnancy-related deaths among women in the United States.

PID affects about one million women in the United States every year, and as many as 7–22 percent of these women may be infected with HIV. Women who have HIV are more susceptible to infections in the lower genital tract, which increases the risk for developing PID.

Further, PID is likely to be more severe and more difficult to treat in women with HIV because HIV impedes the immune system's efforts to fight the infection. Treatment for PID normally involves a strong course of antibiotics and women who have HIV are more likely to need surgical treatment.

Main symptoms of PID include fever, increased vaginal discharge, and lower abdominal pain that tend to persist and range from moderate to severe. Bleeding between periods and/or irregular periods, nausea, and frequent, painful urination also may occur. In many cases, patients have no symptoms and may not even be aware that PID is developing.

Because gynecological infections are one of the first and most common problems in women who have HIV, and because they can lead to PID if left untreated, it is essential that patients have regular Pap smears to screen for vaginal and cervical infections.

Also, it's recommended that women who are infected with HIV do not use an IUD (intrauterine device) as a method of birth control, because this device provides a direct route to the pelvic organs and easy access for bacteria.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 30 Nov 2000

Last Modified: 12 Aug 2015