The goal of treatment is removal of the warts; it is not possible to eradicate the viral infection. Treatment is most successful in patients with small warts that were present for less than 1 year. It is not determined whether treatment of genital warts reduces transmission of HPV. Selection of a specific treatment regimen depends on the anatomic site, size, and number of warts, and expense, efficacy, convenience, and potential adverse effects (Table 18.6). Recurrences more often result from reactivation of subclinical infection than reinfection by a sex partner; therefore, examination of sex partners is not absolutely necessary. However, many of these sex partners may have external genital warts and may benefit from therapy and counseling concerning transmission of warts. HPV infection with types 6,11, 16, and 18 can be prevented by vaccination.
It is estimated that almost 40% to 50% of individuals with HIV are women. Intravenous drug use and heterosexual transmission are responsible for most of the cases of AIDS in women in the United States (52). Infection with HIV produces a spectrum of disease that progresses from an asymptomatic state to full-blown AIDS. The pace of disease progression in untreated adults is variable. The median time between infection with HIV and the development of AIDS is 10 years, with a range from a few months to more than 12 years. In a study of adults infected with HIV, symptoms developed in 70% to 85% of infected adults, and AIDS developed in 55% to 60% within 12 years after infection. The natural history of the disease can be significantly altered by antiretroviral therapy. Women with HIV-induced altered immune function are at increased risk for infections such as tuberculosis (TB), bacterial pneumonia, and Pneumocystis jiroveci pneumonia (PCP). Because of its impact on the immune system, HIV affects the diagnosis, evaluation, treatment, and follow-up of many other diseases and may decrease the efficacy of antimicrobial therapy for some STDs.
Diagnosis Infection is most often diagnosed by HIV antibody tests. Antibody testing begins with a sensitive screening test such as enzyme-linked immunosorbent assay (ELISA) or a rapid assay. If confirmed by Western blot, a positive antibody test result confirms that a person is infected with HIV and is capable of transmitting the virus to others. HIV antibody is detectable in more than 95% of patients within 6 months of infection. Women diagnosed with any STI, particularly genital ulcer disease, should be offered HIV testing (48). Routine HIV screening is recommended for women aged 19 to 64 years and targeted screening for women with risk factors outside of that age range, for example, sexually active adolescents (53).
The initial evaluation of an HIV-positive woman includes screening for diseases associated with HIV such as TB and STIs, administration of recommended vaccinations (hepatitis B, pneumococcal, meningococcal and inﬂuenza), and behavioral and psychosocial counseling. Intraepithelial neoplasia is strongly associated with HPV infection and occurs in high frequency in women with both HPV and HIV.