RISK-FACTORS FOR CHLAMYDIA-TRACHOMATIS PELVIC INFLAMMATORY DISEASE AMONG SEX WORKERS IN NAIROBI, KENYA

Among 302 female sex workers in Nairobi, Kenya, who were followed for 17.6 +/- 11.1 months, 146 had one or more infections with Chlamydia tr achomatis; 102 had uncomplicated cervical infection only, 23 had C. tr achomatis pelvic inflammatory disease (PID), and 21 had combined C. tr achomatis and Neisseria gonorrhoeae PID. As determined by multivariate logistic regression analysis, risk factors for C. trachomatis PID inc luded repeated C. trachomatis infection (odds ratio [OR], 1.8; 95% con fidence interval [CI], 1.3-2.4; P =.0004), antibody to C. trachomatis heat-shock protein 60 (OR, 3.9; CI, 1.04-14.5; P =.04), oral contracep tive use (OR, 0.28; 95% CI, 0.08-0.99; P = .048), and number of episod es of nongonococcal nonchlamydial PID (OR, 1.7; 95% CI, 1.1-2.7; P =.0 2). Among human immunodeficiency virus (HIV)-seropositive women, a CD4 lymphocyte count of <400/mm(3) was an additional independent risk fac tor for C. trachomatis PID (OR, 21.7; 95% CI, 1.2-383; P =.036); among HLA-typed women, HLA-A31 was independently associated with C. trachom atis PID (OR, 5.6; 95% CI, 1.1-29.4; P =.043). The results suggest an immune-mediated pathogenesis for C. trachomatis PID.