Effect of human immunodeficiency virus-1 infection on treatment outcome of acute salpingitis.
OBJECTIVE
To examine the effect of human immunodeficiency virus (HIV)-1 infection on treatment outcome of laparoscopically verified acute salpingitis.


METHODS
Women aged 18-40 years with laparoscopically verified acute salpingitis received antibiotic therapy that included cefotetan 2 g intravenously and doxycycline 100 mg orally every 12 hours and laparoscopically guided drainage of tuboovarian abscesses of 4 cm or more. Clinical investigators blinded to HIV-1 serostatus used predetermined clinical criteria, including calculation of a clinical severity score and a standard treatment protocol to assess response to therapy.


RESULTS
Of the 140 women with laparoscopically confirmed acute salpingitis, 61 (44%) women had mild, 38 (27%) had moderate, and 41 (29%) had severe disease (ie, pyosalpinx, tuboovarian abscesses, or both). Fifty-three (38%) were HIV-1-infected. Severe disease was more common in HIV-1-infected in comparison with HIV-1-uninfected women (20 [38%] compared with 21 [24%], P = .02). Defined as time of hospital discharge or 75% or more reduction in baseline clinical severity score, HIV-1-infected women with severe (6 days [4-16] compared with 5 days [3-9], P = .09) but not those with either mild (4 days [2-6] compared with 4 days [2-6] P = .4) or moderate salpingitis (4 days [3-7] compared with 4 days [3-6] P = .32) tended to take longer to meet criteria for clinical improvement. The need for intravenous clindamycin or additional surgery was not different in HIV-1-infected and uninfected cases (15 [28%] compared with 18 [21%], P = .3).


CONCLUSIONS
Although HIV-1 infection may prolong hospitalization in women with severe salpingitis, all women hospitalized with acute salpingitis responded promptly to antibiotic therapy and surgical drainage regardless of HIV-1 infection status.


METHODS
II-2.
Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya.
Nelly R
NR
Mugo
Julia A
JA
Kiehlbauch
Rosemary
R
Nguti
Amalia
A
Meier
Joseph W
JW
Gichuhi
Walter E
WE
Stamm
Craig R
CR
Cohen
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015313:Cefotetan / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004318:Doxycycline / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D007275:Injections, Intravenous; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015995:Prevalence; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012488:Salpingitis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015313:Cefotetan; D004318:Doxycycline