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To-do list for gynecologic exams in HIV+ patients. (Cervical, Anal Pap Smears).

SAN FRANCISCO--Dr. Meg Dana Newman offered the following tips on conducting gynecologic exams of women who are HIV positive at a meeting on HIV management sponsored by the University of California, San Francisco:

* Conduct a full pelvic examination with cervical and anal Pap smears, said Dr. Newman, director of aids education in the Positive Health Program at San Francisco General Hospital.

* Rule out acute disease, including chlamydia, gonorrhea, and syphilis.

* Include careful inspection of the vulva, the cervix, and the anus for interstitial neoplasms. The human papillomavirus thrives in patients who are immunosuppressed.

* If normal, repeat Pap smears and inspection every 6 months. After two negative Pap smears in a woman with reasonable immune restoration, which she defines as a CD4 count greater than 200 cells/[mm.suo.3], one may extend that interval to 1 year.

* If there is evidence of persistent inflammation, low-grade or high-grade squamous intraepithelial lesions, or atypical squamous or glandular cells of undetermined significance, use colposcopy.

* In talking with the patient, focus on safer sex and pregnancy prevention.

* Suggest that the patient use a barrier method, such as the Reality Female Condom, plus another contraceptive.

* Point out that recent studies have shown that microbicides such as nonoxynol-9 may increase HIV transmission since they often irritate the epithelium.

* Note that oral contraceptives and medroxyprogesterone acetate (DepoProvera) may thin the vaginal epithelium and promote viral shedding.
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Author:Finn, Robert
Publication:OB GYN News
Date:Apr 1, 2003
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