To-do list for gynecologic exams in HIV+ patients. (Cervical, Anal Pap Smears).
* 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.
|Printer friendly Cite/link Email Feedback|
|Publication:||OB GYN News|
|Date:||Apr 1, 2003|
|Previous Article:||Aggressively treat anal warts in HIV+ patients. (May Progress to Anal Cancer).|
|Next Article:||Same lifetime risk of ovarian ca in BRCA1, 2. (Ashkenazi Jewish Population).|