Reviews in Gynaecological Practice 3 (2003) 65–69 Review Human immunodeficiency virus infection in gynaecology H.M. Sebitloane ∗ , B. Hira, J. Moodley Department of Obstetrics and Gynaecology and MRC/UN Pregnancy Hypertension Research Unit, Nelson R Mandela School of Medicine, University of Natal, Private Bag 7, Congella 4013, Durban, South Africa Received 27 March 2003; accepted 14 April 2003 Abstract By the end of 2002, an estimated 40 million people were infected with the human immunodeficiency virus worldwide, the greater proportion of these infections occur in sub-Saharan Africa, where the prevalence is substantially high amongst young women. Females are said to be particularly more susceptible to HIV infection, and it is reported that HIV transmission from men to women is more efficient than from women to men. The presence of a sexually transmitted infection (STI) is known to increase the risk of both acquiring and transmitting the HI virus, whilst the presence of HIV infection, especially advanced disease, may alter the clinical presentation, course and response to conservative treatment for most STIs, as well as pelvic inflammatory disease. Though there are theoretical concerns regarding some methods of fertility control and the risk of HIV acquisition, most contraceptive methods can be used by infected women under close medical surveillance. HIV infection has been associated with an increased prevalence or a more aggressive behavior of certain gynaecological neoplasms. This probably occurs as a result of alterations in the immune response in the lower genital tract to HIV. © 2003 Published by Elsevier Science B.V. Keywords: Human immunodeficiency virus; Infection; Gynaecology; Sexually transmitted infection; Fertility 1. Introduction By the end of 2002, an estimated 40 million people were infected with human immunodeficiency virus (HIV) world- wide, and the majority were living in sub-Saharan Africa, where the prevalence is substantially high amongst young women [1]. Women are said to be particularly more sus- ceptible to HIV infection than men, and studies have shown that HIV transmission from men to women is more ef- ficient than from women to men. The possible explana- tions for this include the fact that the vagina offers a large mucosal surface being exposed to HIV containing genital secretions, the immaturity of the genital tract particularly the transformation zone and cervical ectopy [2] in young women, genital trauma associated with loss of virginity [3], and the presence of sexually transmitted infections (STIs) [1]. HIV infections in women are due mainly to hetero- sexual transmission, it is therefore important to consider its inter-relationship with gynaecological conditions such as genital tract infections, neoplasia, as well as issues regarding reproductivity. ∗ Corresponding author. Fax: +27-31-2604427. E-mail address: gynae@nu.ac.za (H.M. Sebitloane). 2. Genital tract infections The presence of an STI is known to increase the risk of both acquiring and transmitting the HI virus [4], whilst the presence of HIV infection, especially advanced disease, may alter the clinical presentation, course and response to conservative treatment for most STIs [5]. The risk of HIV infection amongst those with ulcerative and non-ulcerative sexually transmitted diseases is increased two-to-five fold [6]. Ulcerative lesions due to herpes simplex virus (HSV), haemophilus ducreyi as well as syphilis have all been in- dependently linked to increased HIV transmission [7]. HIV infected women also have a higher incidence of genital her- pes [8], and may have more florid manifestations of syphilis. Because of high false positive rates, serological tests for syphilis may also be unreliable both for the diagnosis and monitoring of response to therapy in HIV infected women [9]. Cervical inflammation (as is usually seen with neiser- ria gonorrhoea, chlamydia trachomatis, and trichomoniasis) is a strong predictor of cervical HIV detection [10]. These organisms have all been associated with HIV dissemination [7]. Bacterial vaginosis, though not an ulcerative or an in- flammatory condition, has been consistently shown to be associated with HIV seropositivity. Sewankambo et al. [11] 1471-7697/$ – see front matter © 2003 Published by Elsevier Science B.V. doi:10.1016/S1471-7697(03)00050-9