North American Registry of Midwives (NARM) Practice Exam

What is the most common presenting clinical condition in women infected with HIV?

1. Chronic pelvic pain

2. Recurrent or recalcitrant Candida vaginitis

3. Genital warts

4. Pelvic inflammatory disease

The correct answer is: Recurrent or recalcitrant Candida vaginitis

Recurrent or recalcitrant Candida vaginitis is identified as the most common presenting clinical condition in women infected with HIV due to several factors related to the immunocompromised state induced by the virus. HIV attacks and weakens the immune system, particularly affecting CD4 T lymphocytes, which play a crucial role in fighting off infections. As a result, women with HIV often experience altered flora and increased susceptibility to opportunistic infections such as candidiasis. The chronic presence of the virus can disrupt the natural balance of bacteria and fungi in the vaginal environment, leading to an overgrowth of Candida species. This overgrowth manifests as recurrent yeast infections, which may be difficult to treat and may recur frequently even after standard antifungal treatments. In contrast, while chronic pelvic pain, genital warts, and pelvic inflammatory disease can occur in women with HIV, they are not as consistently associated with HIV infection as recurrent Candida vaginitis. The presentation of these conditions is often influenced by various other factors and may not directly correlate with the HIV infection itself. Therefore, the prevalence and recurrent nature of Candida vaginitis in this population make it the most common presenting condition in women infected with HIV.