Clinical Manual for Management of the HIV-Infected ... - myCME.com

Patient Education
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Advise women to wash external genitals daily with a
fresh washcloth or water-soaked cotton balls and to
wipe the vulva and perirectal area from front to back
after toileting. Women should not use baby wipes
on inflamed vulval tissue because they may increase
irritation.
Women should avoid the use of perfumed soaps,
bubble baths, feminine hygiene or vaginal deodorant
products, and bath powders.
Advise women not to douche.
Women should wear cotton underwear and avoid
tight, constrictive clothing, particularly pantyhose.
If women are prescribed medication for vaginal
candidiasis, they should take the medication exactly
as prescribed and finish the medicine even during a
menstrual period.
Women who continue to have symptoms, can
purchase Monistat or Gyne-Lotrimin medication
over the counter. Advise patients to start using these
as soon as symptoms come back, and to call the
clinic if symptoms get worse on these medicines.
Women taking fluconazole or ketoconazole must
avoid pregnancy. Some birth defects have been
reported.
The mineral-oil base in topical vaginal antifungal
preparations may erode the latex in condoms,
diaphragms, and dental dams. Advise patients to use
alternative methods to prevent HIV transmission
or conception or to discontinue intercourse while
using these medications. Nonlatex condoms (plastic
and polyethylene only) or "female" condoms
(polyurethane) can be used.
Sex toys, douche nozzles, diaphragms, cervical caps
and other items, can reinfect patients if not properly
cleaned and thoroughly dried after use.
Some studies have suggested that eating yogurt with
live cultures (check labels) can reduce the occurrence
of vaginal yeast infections.
References
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Section 6—Disease-Specific Treatment | 6–11
Abularach S, Anderson J. Gynecologic Problems.
In: Anderson JR, ed. A Guide to the Clinical
Management of Women with HIV. Rockville, MD:
Health Resources and Services Administration,
HIV/AIDS Bureau; 2005. Available online at hab.
hrsa.gov/publications/womencare05/. Accessed May
19, 2006.
Centers for Disease Control and Prevention.
Sexually transmitted diseases treatment guidelines 2006.
MMWR 2006;55(No. RR-11):1-100.
Cohn SE, Clark RA. Sexually transmitted diseases,
HIV, and AIDS in women. In: The Medical Clinics of
North America, Vol. 87; 2003:971-995.
Hatcher RA, Stewart FH, Trussell J, et al.
Contraceptive Technology, 15th ed. New York: Ardent
Media; 1999:123-5.
Sande MA, Eliopoulos GM, Moellering RC, et al.
The Sanford Guide to HIV/AIDS Therapy, 14th ed.
Hyde Park, VT: Antimicrobial Therapy, Inc.; 2005.
Spence D. Candidiasis (vulvovaginal). Clin Evid.
2004 Dec;(12):2493-511.
U.S. Public Health Service, Infectious Diseases
Society of America. Guidelines for preventing
opportunistic infections among HIV-infected
persons--2002. MMWR Recomm Rep. 2002 Jun
14;51(RR08);1-46. Available online at aidsinfo.nih.
gov/Guidelines/. Accessed May 19, 2006.