Effects of human immunodeficiency virus 1 infection on microbial origins of pelvic inflammatory disease and on efficacy of ambulatory oral therapy.
OBJECTIVE
This study was undertaken to determine the effects of human immunodeficiency virus 1 infection on the clinical presentation, severity, causal organisms, and response to ambulatory therapy of pelvic inflammatory disease.


METHODS
Women 18 to 40 years old with lower abdominal pain for <1 month were recruited. Participants underwent a standardized questionnaire, physical examination, screening for human immunodeficiency virus 1 and other sexually transmitted infections, and endometrial biopsy to detect plasma cell endometritis. Reevaluations were performed at 1 and 4 weeks to assess response to therapy.


RESULTS
Among 162 women with adequate endometrial biopsy specimens 63 (39%) had histologically confirmed endometritis. Endometritis was more frequent among women who were seropositive for human immunodeficiency virus 1 than among women who were seronegative (odds ratio, 3.0; 95% confidence interval, 1.5-5.9). Infections with either Neisseria gonorrhoeae or Chlamydia trachomatis, or both, were least common and bacterial vaginosis was most common among human immunodeficiency virus 1-infected women with CD4 T-lymphocyte counts <400 cells/microL (P <. 04, P <.03, respectively). After oral antibiotic therapy, similar proportions of both women who were seropositive and women who were seronegative for human immuno-deficiency virus 1 had a >/=75% reduction in clinical severity score (81% vs 86%).


CONCLUSIONS
Outpatient treatment of pelvic inflammatory disease was successful regardless of human immunodeficiency virus 1 serostatus.
Bukusi
E A
EA
Center for Microbiology Research, Kenya Medical Research Institute, University of Nairobi.
Cohen
C R
CR
Stevens
C E
CE
Sinei
S
S
Reilly
M
M
Grieco
V
V
Eschenbach
D A
DA
Holmes
K K
KK
Bwayo
J
J
Ndinya-Achola
J O
JO
Kreiss
J
J
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D004716:Endometritis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006069:Gonorrhea / Q000382:microbiology; D015483:HIV Antibodies / Q000097:blood; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D015999:Multivariate Analysis; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016585:Vaginosis, Bacterial / Q000453:epidemiology / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D015483:HIV Antibodies