CDC NATIONAL AIDS HOTLINE TRAINING BULLETIN #19 - December 17, 1992
Centers for Disease Control and Prevention

1. What is the relationship between vaginal yeast infections and HIV infection or AIDS?

Frequent or persistent cases of vaginal fungal infections known as "yeast" infections, or vaginal candidiasis, or monilia may sometimes be an early symptom of infection with the human immunodeficiency virus, HIV, that causes AIDS. Most of the 13 million cases of vaginal candidiasis that occur annually do NOT have HIV as an underlying cause. Pregnancy, diabetes, contraceptive pills, and antibiotics are commonly linked to these fungal infections. However, women at risk for HIV infection should be aware of the possibility that recurrent or stubborn cases of vaginal candidiasis sometimes may be an early sign of HIV infection, and should check with a doctor.

2. How often are vaginal yeast infections a symptom of HIV infection?

Very few scientific articles have been published about vaginal candidiasis in HIV-infected women. One study showed that, of women diagnosed with HIV-caused immunosuppression, 38 percent suffered recurring or persistent cases of vaginal candidiasis as their first symptom. However, other studies of vaginal candidiasis have reported a much smaller percentage, usually between 10 percent and 20 percent of HIV-infected women, with this diagnosis. Vaginal yeast is already present in 15 percent to 20 percent of healthy, asymptomatic, HIV-negative women, so how often vaginal yeast infections are associated with HIV infection is still unclear.*

3. Why is there a warning label on nonprescription drugs for vaginal candidiasis?

The Food and Drug Administration (FDA) has requested that manufacturers of nonprescription drugs for vaginal candidiasis include a new label warning that women who may have been exposed to HIV infection and who experience recurrent or persistent cases of vaginal yeast infections should seek professional medical attention promptly. Miconazole nitrate, marketed under the name brand Monistat-7, and clotrimazole, marketed as Gyne-Lotrimin, Mycelex-7, and FemCare, are sold without prescription for treatment of vaginal candidiasis in patients who have had a previous episode of vaginal candidiasis diagnosed by a physician. The labeling of these products already states that recurrent infections may result from hormonal changes or use of oral contraceptives or antibiotics. The additional warning will state, "In women with frequently recurrent vaginal yeast infections, especially infections that don't clear up easily with proper treatment, the vaginal yeast infections may also be the result of serious medical conditions, including infection with HIV, that can damage the body's normal defense against infection."

*Additional references:

Carpenter CCJ, Mayer KH, Fischer A, et al. Natural history of acquired immunodeficiency syndrome in women in Rhode Island. Am J Med 1989;86:771-5.

Imam N, Carpenter CCJ, Mayer KH, et al. Hierarchical pattern of mucosal candida infections in HIV-seropositive women. Am J Med 1990;89:142-6.

Carpenter CCJ, Mayer KH, Stein MD, et al. Human immunodeficiency virus infection in North American women: experience with 200 cases and a review of the literature. Medicine 1991;70:307-25.

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