Reproductive and gynecological conditions common among adolescent girls, in general and among HIV-infected girls specifically, include delayed puberty; menstrual disorders, such as abnormal uterine bleeding (amenorrhea, hyperandrogenism, oligomenorrhea, and dysfunctional uterine bleeding [DUB]); dysmenorrhea; premenstrual syndrome; and pregnancy. Infectious gynecological conditions include vulvovaginal candidiasis, bacterial vaginosis (BV), trichomoniasis, atypical infections of the female genital tract, cervicitis, pelvic inflammatory disease (PID), human papillomavirus infection (HPV), and herpes simplex virus (HSV) infection. This chapter addresses common reproductive health disorders among HIV-infected adolescents, and also includes a description of risk factors unique to adolescents that contribute to the acquisition of sexually transmitted infections as well as age-appropriate recommendations for secondary prevention. Most reproductive health disorders among HIV-infected adolescent girls are best managed by an adolescent medicine physician. Certain patients, such as those with delayed puberty, amenorrhea, and hyperandrogenism should be managed in collaboration with an endocrinologist.
Common non-infectious reproductive and gynecological conditions
HIV-infected adolescents, similar to their uninfected counterparts, may experience delayed puberty and menstrual disorders. In addition to these conditions, we will discuss particular considerations related to contraception and pregnancy.
Diagnosing delayed puberty may be difficult due to wide ethnic and regional variations in normal development [1–5]. Pubertal maturation in girls begins with the acceleration of growth followed by onset of breast development (thelarche) between the ages of 8 and 13 years.