[health menu] XI International Conference on AIDS
July 7-12, 1996

Bukusi Elizabeth*, Stevens C.**,
Cohen C.**, Sinei S., Moses S.***
University of Nairobi

Ndinya-Achola J.O.
*Kenya Medical Research Institute

Reilly M., Holmes K., Kreiss J.
**University of Washington

***University of Manitoba


Impact of HIV on Acute Pelvic Inflammatory Disease in a Nairobi outpatient Clinic


This study was designed to characterize the demographic, clinical, and microbiological factors associated with clinically diagnosed PID at an outpatient clinic in Nairobi, Kenya, and to determine the effect of HIV serostatus on clinical presentation, severity, and etiology of acute PID.


Women aged 18-40 years presenting to two city council clinics with complaints of lower abdominal pain for less than one month duration were recruited. Participants underwent a standardized questionnaire, physical examination, and assignment of a clinical severity score (cervical motion tenderness (0-3), uterine tenderness (0-3), adnexal tenderness (0-6), direct abdominal tenderness (0-12), rebound tenderness (0-12)). HIV serology, STD screening, as well as endometrial biopsies to assess for the presence of endometritis were performed.


235 women were recruited during 1994 and 1995. HIV seroprevalence was 32%. HIV seropositive and seronegative women had a similar mean age (25.7 vs. 25.4, p=.6), but the former were significantly more likely to have a history of prostitution (35% vs. 14%, OR 1.6, 95% CI 1.2-2.3), and a greater median number of lifetime sexual partners (6 vs. 3, p<.001). Clinical manifestations (history of fever, nausea, chills, low back pain, abnormal vaginal discharge, and urethral symptoms) were similar in the two groups, as was the mean clinical severity score (8.0 vs. 7.3, p=.3). On pelvic examination HIV seropositive women were more likely to have a pelvic mass (7% vs. 1%, OR 11.2, 95% CI 1.3-98.0). N. gonorrhoeae was detected in 62 (27%) and C. trachomatis in 26 (14%). The prevalence of gonorrhea and chlamydia did not differ by HIV serostatus. Bacterial vaginosis by clinical criteria was more common in the HIV seropositive patients (40% vs. 23%, OR 1.3, CI 1.1-1.7). Clinical and microbiologic response to therapy did not differ by HIV serostatus, and no patient required hospitalization.


In an outpatient clinic in Nairobi 32 % of patients with a clinical diagnosis of acute PID had concomitant HIV infection. Pelvic masses occurred with increased frequency among HIV seropositive subjects.

Dr. Elizabeth Bukusi
Medical Microbiology Annexe
P.O. Box 19676, Nairobi, Kenya
Tel: 254-2-714851; Fax: 254-2-712007

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Created: July 16, 1996
Last modified: July 17, 1996

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