Standards of care

Primary care guidelines developed by the Infectious Diseases Society of America (IDSA) recommend that a comprehensive gynaecological history be obtained at an initial visit, covering the following elements:¹

• Menstrual history
• Sexual practices
• Contraception history and current use
• Use of the male or female condom and consistency of use
• Prior genital tract or sexually transmitted infections
• Any abnormal Pap smear results, including evaluation and follow-up
• Past gynaecologic conditions or surgeries, including work-ups for uterine fibroids, endometriosis and infertility
• Current gynaecologic symptoms, including abnormal vaginal discharge or bleeding, amenorrhoea and pelvic pain. 

Beyond routine evaluation and laboratory testing, cervical cytology screening, such as a Papanicolaou test (Pap smear) is recommended at the initiation of care, to be repeated at six months. If normal, the test should be done yearly to screen for changes in cervical cytology. All atypical findings require follow-up so as to detect potential cervical cancer development early.

Mammography is generally done annually in women aged 50 and over, but this should follow national or WHO guidelines.

Bone densitometry is recommended at baseline for postmenopausal women or younger if there are risk factors for premature bone loss. Premature bone loss has been associated with the use of some antiretroviral drugs.

It is recommended that new patients be screened for syphilis, trichomoniasis, chlamydia and gonorrhoea. 

Given the increased risk of human papillomavirus (HPV) infection and development of cervical cancer that accompanies HIV infection, the preventive quadrivalent HPV vaccine is recommended for females aged 13 to 26 years, unless the CD4 count is less than 200 cells/mm³. The vaccine needs to be given to someone who has not been previously exposed to HPV through sexual contact.²

Women who have never had chickenpox or shingles or who test seronegative for varicella zoster virus (VZV), should receive post-exposure prophylaxis with VZV immune globulin (VariZIG) within 96 hours after exposure to someone with either illness. Vaccination against varicella should be considered in anyone VZV-seronegative if the CD4 cell count is over 200 cells/mm³.