Lecture | Quiz | Learning Exercise | Answer Key

Developed by JHPIEGO’s Training in Reproductive Health Project with funding from USAID.

Lesson 7: Other Reproductive Health Issues Among HIV-Infected Individuals
Instructor: Jean Anderson, MD

Answer Key

Quiz 

1. Which of the following interventions may decrease the transmission of HIV?
   1. Correction of anemia
   2. Screening and treatment of STIs
   3. VIA and cryotherapy
   4. Use of combined oral contraception
2. HPV and HIV coinfection are associated with:
   1. Shorter persistence of HPV
   2. Increased rates of cervical dysplasia
   3. Longer time from initial infection with HPV to development of cervical dysplasia
   4. Increased likelihood of nononcogenic HPV types
3. Bacterial vaginosis (BV) has been associated with increased risk of:
   1. HIV transmission
   2. Menstrual disorders
   3. Syphilis
   4. Anemia
4. Syndromic management is most accurate in the diagnosis and treatment of:
   1. HPV
   2. Gonococcal (GC) cervicitis
   3. Syphilis
   4. Cervical dysplasia

Learning Exercise

1. The most likely diagnosis in a young woman with abdominal, adnexal, and cervical motion tenderness, as well as fever and purulent vaginal discharge is pelvic inflammatory disease (PID). Most of the time, even when the woman is HIV+, this is caused by a variety of different aerobic and anaerobic bacteria, and is often initiated by a sexually transmitted organism, such as gonorrhea or chlamydia. In addition to these "usual suspects", if the HIV+ woman is very immune-suppressed, PID can be caused by other opportunistic infections, such as TB or CMV. In general, in the HIV-infected woman, PID may be more severe, require longer treatment, and may be more likely to require surgical intervention. 
   
   This scenario raises several other important reproductive health issues. Since PID is usually a sexually transmitted infection, it is unlikely that she has been having protected sexual activity. This may put her at risk for other serious infections, such as syphilis; she may be at risk for becoming pregnant; on the other hand, PID increases her risk of infertility if she should want to become pregnant in the future. She is also at increased risk of transmitting HIV to her sexual partners and the presence of an STD increases that risk. She needs to be counseled carefully about safer sexual practices.
2. HIV has been associated with decreased fertility in both symptomatic and asymptomatic women. There are several potential reasons for this. Women with HIV are more likely to have acquired another sexually transmitted infection, just as they likely acquired HIV, thru unsafe sex. These other STIs can cause tubal damage (even in the absence of symptoms of PID) resulting in infertility. Women with late stage HIV or AIDS may have decreased desire to have sex because they feel ill and may have ovulatory dysfunction because of chronic illness and weight loss. If they do become pregnant they may be at higher risk of spontaneous abortion. Finally, the male partner may also be infected and HIV has been associated with abnormal semen analyses.
   
   This information should be used to counsel women about HIV. For the woman who is not HIV-infected, knowing about the adverse effect of HIV on her fertility may encourage her to be careful and to use condoms until she is ready to get pregnant and to consider HIV counseling and testing with her partner when preparing to try to conceive. The woman who is HIV+ should also use condoms to protect herself from other STIs. She should be encouraged to discuss these issues with her partner.