The associations between pelvic inflammatory disease, Trichomonas vaginalis infection, and positive herpes simplex virus type 2 serology

Sex Transm Dis. 2006 Dec;33(12):747-52. doi: 10.1097/01.olq.0000218869.52753.c7.


Objective: Roles for Chlamydia trachomatis and Neisseria gonorrhoeae infections in pelvic inflammatory disease pathogenesis are well delineated; however, the etiologic contributions of herpes simplex virus type 2 (HSV-2) and Trichomonas vaginalis have been underexplored.

Goal: The goal of this study was to investigate the association between acute and plasma cell endometritis, fallopian tube obstruction, HSV-2 serology, and T. vaginalis infection.

Study design: The authors conducted a cross-sectional secondary analysis of 736 women at risk for bacterial sexually transmitted diseases that used endometrial biopsy data obtained at enrollment as well as hysterosalpingography results obtained 12 weeks after enrollment.

Results: Women diagnosed with T. vaginalis at enrollment were more likely to have histologic evidence of acute endometritis. Both plasma cell and acute endometritis were significantly more common among women with positive serology HSV-2; furthermore, women coinfected with HSV-2 and C. trachomatis, N. gonorrhoeae, T. vaginalis, or bacterial vaginosis were much more likely to be diagnosed with acute endometritis than were women infected with HSV-2 or one of these pathogens alone. Among women with available HSV-2 serology and hysterosalpingogram results, HSV-2 was the only genital tract pathogen infection associated with fallopian tube obstruction.

Conclusions: Our analyses demonstrate that T. vaginalis infection and positive HSV-2 serology are associated with endometritis. Further work will be needed to determine the specific roles these pathogens may play in pelvic inflammatory disease pathogenesis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Animals
  • Antigens, Viral / analysis
  • Cohort Studies
  • Cross-Sectional Studies
  • DNA, Protozoan / analysis
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Herpesvirus 2, Human / immunology
  • Herpesvirus 2, Human / isolation & purification*
  • Humans
  • Pelvic Inflammatory Disease / blood
  • Pelvic Inflammatory Disease / epidemiology
  • Pelvic Inflammatory Disease / microbiology*
  • Pelvic Inflammatory Disease / parasitology
  • Pelvic Inflammatory Disease / virology
  • Pennsylvania / epidemiology
  • Polymerase Chain Reaction
  • Prevalence
  • Sexually Transmitted Diseases / blood
  • Sexually Transmitted Diseases / epidemiology
  • Sexually Transmitted Diseases / microbiology*
  • Sexually Transmitted Diseases / parasitology
  • Sexually Transmitted Diseases / virology
  • Trichomonas vaginalis / genetics
  • Trichomonas vaginalis / isolation & purification*


  • Antigens, Viral
  • DNA, Protozoan