BACTERIURIA IN A COHORT OF PREDOMINANTLY HIV-1 SEROPOSITIVE FEMALE COMMERCIAL SEX WORKERS IN NAIROBI, KENYA

Although significant bacteriuria and urinary tract infection are more common in immunocompetent women than men, studies linking HIV immunosu ppression with and increased risk of developing urinary infection have so far only been carried out in men. We therefore examined the relati onship between bacteriuria and HIV status and CD4 + cell count in a re latively homogenous cohort of female commercial sex workers (CSW) atte nding a community clinic in Nairobi. Two hundred and twenty-two women were enroled, and grouped according to HIV status and CD4 count. Group 1 were HIV seronegative (n = 52); Group 2 were HIV seropositive with CD4 + counts above 500 x 10(6)/l (n = 51); Group 3 were HIV seropositi ve with CD4 + counts between 201 and 500 x 10(6)/l (n = 67); Group 4 w ere HIV seropositive with CD4 + counts below 200 x 10(6)/l (n = 52). C linical signs and symptoms were noted and mid-stream specimens of urin e obtained for culture and sensitivity. Overall 23% (50/222) had signi ficant bacteriuria. The rates in each group respectively were 25%, 29% , 19% and 23% and there was no significant association between bacteri uria and HIV status; or between bacteriuria and level of immunosuppres sion as indicated by CD4 + count. Overall 19% (30/222) of women had sy mptoms (frequency; dysuria; loin pain; smelly urine) or signs (fever; loin tenderness) compatible with urinary tract infection. However ther e was no significant association between symptoms or sings of infectio n and bacteriuria or HIV status. A typical range of pathogens, predomi nantly Enterobacteriaceae, were isolated and ther were high rates of r esistance to commonly used antimicrobials as well as 10% resistance to ciprofloxacin. Although high rates of significant bacteriuria can occ ur in highly sexually-active women, this appears Unrelated to HIV infe ction or the level of HIV-related immunosuppression and is generally a symptomatic or clinically indistinct.