Effects of human immunodeficiency virus 1 infection on microbial origins of pelvic inflammatory disease and on efficacy of ambulatory oral therapy

Am J Obstet Gynecol. 1999 Dec;181(6):1374-81. doi: 10.1016/s0002-9378(99)70378-9.


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.

Study design: 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%).

Conclusion: Outpatient treatment of pelvic inflammatory disease was successful regardless of human immunodeficiency virus 1 serostatus.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Ambulatory Care
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Chlamydia Infections / microbiology
  • Chlamydia trachomatis / isolation & purification
  • Endometritis / complications
  • Endometritis / drug therapy*
  • Endometritis / epidemiology
  • Endometritis / microbiology*
  • Female
  • Gonorrhea / microbiology
  • HIV Antibodies / blood
  • HIV Seropositivity / complications*
  • HIV Seropositivity / epidemiology
  • HIV-1* / immunology
  • Humans
  • Kenya / epidemiology
  • Multivariate Analysis
  • Neisseria gonorrhoeae / isolation & purification
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome
  • Vaginosis, Bacterial / epidemiology
  • Vaginosis, Bacterial / microbiology*


  • Anti-Bacterial Agents
  • HIV Antibodies