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mycobacterial infections, with symptoms similar to acute prostatitis, and a fluctuant mass may be
palpated. The risk for prostate abscess and urosepsis is increased with HIV infection. Urine
cultures often show sterile pyuria, although blood cultures may be positive.[919]
Prostatitis may be found in 3% of men with HIV, and 14% of men with AIDS,
compared with rates of 1% to 2% in the general population. The complication of prostatic
abscess is more common as well. Despite antibiotic therapy, relapse is common. Prostate and
seminal vesicle are occasionally the site for KS and CMV when these processes are widely
disseminated. One important finding in prostate is cryptococcal prostatitis, typically seen with
disseminated cryptococcosis. Prostatic involvement may result in clinical difficulties in
treatment because of the inability of antifungal agents to reach the prostatic glands in high
concentration, so that the prostate remains a reservoir for reinfection. Obstructive uropathy does
not occur from these lesions.[919]
In a study of HIV-infected men receiving antiretroviral therapy, the clinical presentation,
age at diagnosis, and prostate specific antigen (PSA) levels did not appear to be altered by their
HIV status. Their disease management and outcome was similar to HIV negative men.[942]
Seminal vesicles can harbor macrophages infected with HIV that contribute to the
infectivity of seminal fluid. Thus, the seminal vesicles can serve as a reservoir for HIV.[136]
Penile intraepithelial neoplasia and carcinoma occur with increased frequency in HIV
positive men having sex with men. Human papillomavirus (HPV) infection involving penile
shaft, and scrotum range is often present. There may be concomitant anal squamous
intraepithelial lesions.[713]

FEMALE GENITAL TRACT.-- Opportunistic infections with AIDS are uncommon in
the female genital tract. Vulvovaginal candidiasis occurs with higher incidence and greater
persistence, but not greater severity, among HIV-infected women.[943] Additional sexually
transmitted diseases, including gonorrhea, syphilis, and Chlamydia are also more frequently seen
in HIV-infected persons and require appropriate diagnostic procedures and treatment. Kaposi's
sarcoma and lymphoma are rare at these sites with AIDS.
Women with HIV infection are more likely to have concomitant human papillomavirus
(HPV) infection, infection with multiple HPV subtypes (including the high-risk HPV16 and 18
subtypes), and have a subsequent higher risk for cervical intraepithelial neoplasia (CIN),
particularly high grade CIN, and invasive cervical squamous cell carcinomas. The
immunosuppression induced by HIV leads to inadequate clearance with persistence of HPV
infections.[944] HIV-infected women have more vulvar, vaginal, and perianal intraepithelial
lesions than HIV-uninfected women.[945]
The risk for developing cervical squamous intraepithelial lesions (SILs) in HIV-infected
women is 17% after 1 year and 48% after 5 years, and the risk increases for younger women and
those with higher initial viral load; the prevalence of SIL is related to reduced CD4 lymphocyte
count. The morphologic appearances of such lesions include atypical glandular cells of uncertain
significance (AGUS), atypical squamous cells of uncertain significance (ASCUS), low-grade
SIL (LSIL), and high-grade SIL (HSIL).[946] Such patients are more likely to have
symptomatic human papillomavirus (HPV) infections when the CD4 lymphocyte count is
<200/µL, particularly with the viral types HPV-16 and HPV-18 that are more often associated
with dysplasias and malignancies of squamous epithelium. Thus, these high grade squamous
epithelial lesions occur both as a consequence of sexually transmitted HPV infection and through
promotion by concomitant immunosuppression with HIV infection.[947] The 1993 CDC