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

OBJECTIVE: This study was undertaken to determine the effects of human immu nodeficiency virus 1 infection on the clinical presentation, severity, caus al organisms, and response to ambulatory therapy of pelvic inflammatory dis ease. STUDY DESIGN: Women 18 to 40 years old with lower abdominal pain for <1 mon th were recruited. Participants underwent a standardized questionnaire, phy sical examination, screening for human immunodeficiency virus 1 and other s exually transmitted infections, and endometrial biopsy to detect plasma cel l endometritis. Reevaluations were performed at 1 and 4 weeks to assess res ponse 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 trach omatis, or both, were least common and bacterial vaginosis was most common among human immunodeficiency virus 1-infected women with CD4 T-lymphocyte c ounts <400 cells/mu L (P < .04, P < .03, respectively). After oral antibiot ic therapy, similar proportions of both women who were seropositive and wom en who were seronegative for human immunodeficiency virus 1 had a greater t han or equal to 75% reduction in clinical severity score (81% vs 86%). CONCLUSION: Outpatient treatment of pelvic inflammatory disease was success ful regardless of human immunodeficiency virus 1 serostatus.