Health News and Information

As discussed previously, although women make up a relatively small percentage of those infected with HIV and those with AIDS itn the United States, they are one of the fastest-growing groups among the newly infected. Most often these are women who are at some risk for HIV such as those who use injection drugs and share works, or who have a sexual partner who is an injection drug user. Women often have a poorer prognosis than men, possibly because of inadequate access to health care.

Until recently, research into HIV and its clinical manifestations has focused on men, but we are now beginning to have a better idea of how HIV affects women. The treatment regimens for HIV are currently the same for women as for men (see the section on treatment), but there are differences between women and men with HIV infection. Women with HIV infection are more likely to have such AIDS-deflning illnesses as Candida (yeast) in the throat, recurrent bacterial pneumonia, and progressive multifocal leukencephalopathy. Men, on the other hand, are more likely to have such illnesses as Kaposi’s sarcoma, oral hairy leukoplakia, Pneumocystis carinii pneumonia, and prolonged herpes outbreaks.

Women with HIV infection and AIDS are also at high risk for gynecological problems. Infected women acquire cervical cancer more often than women without HIV and the course of the cancer can be much more aggressive. Therefore, women with HIV infection and AIDS should be screened for cervical cancer more closely (every six months) than other women (for whom annual Pap smears are recommended).The treatment of cervical cancer is the same for both groups. Frequent yeast infections can be a sign of HIV infection in otherwise healthy women, but the connection is by no means automatic (see “Fungal Infections”). In addition, women infected with HIV are more likely to have problems with their periods and to experience early menopause.

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When a woman has her yearly examination, she should speak with her health care provider about her Pap smear results and understand what they mean. She may also want to ask for a copy of the results for her own files.

When the Pap smear result indicates an abnormality of dysplasia or cancer, there are several options for removing warts on the cervix.

They can be treated by cryotherapy, removal of part of the cervix, laser surgery, loop electrode excision, or surgical excision, including cervical conization (in which a cone of tissue is removed from the cervix). Even advanced lesions may be cured with these procedures.

The progression from precancerous changes to cervical cancer is very slow. Many women with HPV are concerned about the risk of cervical cancer, fearing that they have a ticking time bomb inside them. Yet this is simply not true for the majority of women with HPV If a woman follows the recommendations given here, having routine Pap smears and appropriate follow-up and treatment of any visible external warts, then she need not worry unduly about the risk of cancer. Certainly most of the millions of women infected with HPV do not develop these complications.

A final note. The Pap smear is not a test for STDs, such as chlamydia and gonorrhea, although many people mistakenly think that it does provide a screen for all STDs. Specific tests must be performed for these infections. Sexually transmitted infections such as herpes (if there are lesions on the cervix) and mucopurulent cervicitis can cause inflammation on the cervix, which also may result in an abnormal Pap smear. It is often better to defer the Pap smear until these infections have been treated and have resolved, so that the Pap smear can accurately perform its intended function: identifying problems caused by the warts virus.

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Those with same-sex partners face specific STD risks. Some misperceptions must also be discussed, and I try to address them here as clearly as possible. Although nearly 10 percent of sexually active adults engage in sex with partners of the same sex, considerable misunderstanding and stigma are still associated with same-sex relationships among the general public, in the media, and among health professionals as well. Many people in same-sex relationships find it difficult to discuss their sexuality openly with a health care provider or are discouraged in their efforts because the health care provider is so clearly uncomfortable. Under these circumstances a person is less likely to receive the high-quality health care that he or she deserves.

Until fairly recently, there had been little research into the sexual health risks faced by same-sex couples. Awareness of HIV and the prevalence of this infection among men who have sex with other men in the United States has led to more sexual health-related research in the last fifteen years, but there has still been remarkably little research addressing lesbian women and their risk for acquiring STDs. The sections that follow will cover some of these specific risks.

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Unless you talk honestly about your sexual health, your health care provider may not be aware that you need or want to be screened for STDs. Some health care providers don’t routinely screen their patients for STDs unless they think the patient is at high risk. Don’t assume that your health care provider has performed an STD screening just by looking at the genital area or by doing a Pap smear. The physical examination is just one of the steps in the screen. Specific tests must be done to screen for most STDs.

A full STD screen includes evaluation for the following (the diseases are listed in alphabetical order, not in order from most common to least common or vice versa):

1. Bacterial vaginosis, for women (not an STD)

2. Chancroid, donovanosis, and lymphogranuloma venereum. (These are not routinely screened for in most areas of the country because they are very rare. You may be screened if you are at risk, or if you show symptoms of these STDs on examination. See the descriptions of specific STDs in Part II to determine if you are at risk.)

3. Chlamydia

4. Genital warts, and a Pap smear for women if one has not been performed in the past year

5. Gonorrhea

6. Hepatitis B and possibly A or C

7. Herpes

8. Human immunodeficiency virus (HIV)

9. Intestinal infections for recipients of anal sex or those who practice oral-anal sex

10. Lice and scabies

11. Molluscum contagiosum

12. Mucopurulent cervicitis (for women)

13. Nongonococcal urethritis (for men)

14. Syphilis

15. Trichomonas

16. Yeast (not an STD)

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The urethra is a hollow tube that leads from the bladder, through the prostate gland, and through the penis to open at the tip of the glans. It carries urine to the outside of the body to empty the bladder. The vas deferens lead sperm from the testicles into the urethra during ejaculation. In addition, there are glands called the seminal vesicles that empty fluid into the urethra during ejaculation. The ejaculate, called semen, contains a mixture of sperm and secretions from the vas deferens, the seminal vesicles, and the prostate. Pre-ejaculate, the small amount of fluid released before ejaculation, may contain sperm and cause pregnancy, and it may transmit infection as well. The urethra should not burn or itch, and normally there should not be any discharge from it. The urethra can become infected with bacteria (such as those that cause gonorrhea, chlamydia, and nongonoccal urethritis), viruses (herpes, genital warts), and protozoa (trichomoniasis) through sexual contact.

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