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Effect of Human Immunodeficiency Virus-1 Infection on Treatment Outcome of Acute Salpingitis

From the ¹Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya; ²Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; the Departments of ³Obstetrics and Gynecology and ⁴Medicine, University of Washington, Seattle, Washington; and the Departments of ⁵Statistics and ⁶Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.

OBJECTIVE: To examine the effect of human immunodeficiency virus (HIV)–1 infection on treatment outcome of laparoscopically verified acute salpingitis.

METHODS: Women aged 18–40 years with laparoscopically verified acute salpingitis received antibiotic therapy that included cefotetan 2 g intravenously and doxycycline 100 mg orally every 12 hours and laparoscopically guided drainage of tuboovarian abscesses of 4 cm or more. Clinical investigators blinded to HIV-1 serostatus used predetermined clinical criteria, including calculation of a clinical severity score and a standard treatment protocol to assess response to therapy.

RESULTS: Of the 140 women with laparoscopically confirmed acute salpingitis, 61 (44%) women had mild, 38 (27%) had moderate, and 41 (29%) had severe disease (ie, pyosalpinx, tuboovarian abscesses, or both). Fifty-three (38%) were HIV-1–infected. Severe disease was more common in HIV-1–infected in comparison with HIV-1–uninfected women (20 [38%] compared with 21 [24%], P = .02). Defined as time of hospital discharge or 75% or more reduction in baseline clinical severity score, HIV-1–infected women with severe (6 days [4–16] compared with 5 days [3–9], P = .09) but not those with either mild (4 days [2–6] compared with 4 days [2–6] P = .4) or moderate salpingitis (4 days [3–7] compared with 4 days [3–6] P = .32) tended to take longer to meet criteria for clinical improvement. The need for intravenous clindamycin or additional surgery was not different in HIV-1–infected and uninfected cases (15 [28%] compared with 18 [21%], P = .3).

CONCLUSION: Although HIV-1 infection may prolong hospitalization in women with severe salpingitis, all women hospitalized with acute salpingitis responded promptly to antibiotic therapy and surgical drainage regardless of HIV-1 infection status.

LEVEL OF EVIDENCE: II-2

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