Care of vaginal symptoms among HIV-infected women

Objective: Gynecologic disease is common in HIV-infected women. We examine the sociodemographic, clinical, and provider factors associated with the ca re of women with vaginal symptoms. Methods: Women enrolled in the HIV Cost and Services Utilization Study (HCS US), a nationally representative probability sample of HIV-infected adults, were interviewed between January 1996 and April 1997. Women with vaginal s ymptoms who sought medical attention were asked, "Did your health care prov ider examine your vaginal area?" Women were also asked if they received med ication for their symptoms. Results: Among 154 women with vaginal symptoms, 127 sought care for their s ymptoms. Of those who sought care, 48% saw a gynecologist and 52% sought ca re from nongynecologists, most often their usual HIV care provider. Women w ho saw a gynecologist for their symptoms were more likely to have received a pelvic examination (92% versus 76%; p = .06) and vaginal fluid collection (98% versus 88%; p = .06) than those who saw their regular HIV provider. F ifteen percent of women received medication for their symptoms without havi ng a pelvic examination; gynecologists were less likely to prescribe withou t an examination (8% versus 21%; p = .12). Conclusion: Gynecologists are more likely to provide adequate care of vagin al symptoms among HIV-infected women than nongynecologists who were HIV car e providers. This specialty difference is consistent with quality of care s tudies for other medical conditions, but the potential gynecologic complica tions of inadequate evaluation and treatment warrants further investigation .