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Special Considerations in the Management of HIV in Women, Including During Conception and Pregnancy

Joseph J. Eron, Jr., MD
Program Director
Daniel R. Kuritzkes, MD
Program Director
Judith S. Currier, MD, MSc
Sigal Yawetz, MD
Released: May 21, 2020

Sexually Transmitted Diseases in Women with HIV

Unprotected sexual intercourse is the most common mode for transmission of HIV and other STDs.[79] The presence of an STD in individuals with HIV can facilitate HIV transmission by increasing genital shedding of HIV.[80,81] Therefore, detection and treatment of STDs are an important part of an HIV prevention strategy.

Women should be counseled routinely to use barrier contraceptive methods to prevent acquisition of an STD, even if other contraceptive methods are already in use. Routine screening for STDs should occur in sexually active women and should be performed more often in the following situations:

  • With a new HIV diagnosis
  • At each annual examination
  • With a new sexual partner
  • Following a condom malfunction
  • After unprotected intercourse
  • When there is a known exposure to an STD

Women should be evaluated for the following STDs:

  • Gonorrhea/chlamydia
    • Screen annually in sexually active women, women with recent change in sexual partner or sexual practice, if partner has a history of STDs, or if the woman presents with signs or symptoms
  • Trichomonas vaginalis
  • Syphilis
    • Should be screened for annually and if neurologic symptoms occur
  • Herpes simplex virus
  • Bacterial vaginosis
    • Although not an STD, bacterial vaginosis increases HIV infectiousness[82]
  • Vulvovaginal candidiasis
    • Recurrent episodes may be an indication of HIV disease progression
  • HPV
    • Refer to cervical cancer screening

Women who test positive for gonorrhea, chlamydia, trichomonas, or syphilis should be counseled regarding safe sexual practices and the use of barrier contraception. Gonorrhea, chlamydia, chancroid, and syphilis are reportable STDs according to the CDC guidelines.[83] The guidelines for reporting of specific STDs vary by state.

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