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Infectious Diseases in Obstetrics and Gynecology
Volume 2011, Article ID 407057, 6 pages
http://dx.doi.org/10.1155/2011/407057
Research Article

Endometrial Histopathology in Patients with Laparoscopic Proven Salpingitis and HIV-1 Infection

1Department of Obstetrics and Gynecology, Kenyatta National Hospital, P.O. Box 19865-00202, Nairobi, Kenya
2Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
3Department of Pathology, Harborview Medical Center, UW Medicine Pathology, University of Washington, P.O. Box 357470, Seattle, WA 98195-7470, USA
4Maryland Department of Health and Mental Hygiene, 201 West Preston Street, Baltimore, MD 21201, USA
5Department of Statistics, University of Nairobi, Nairobi, Kenya
6Department of Obstetrics and Gynecology, University of Nairobi, School of Medicine, Kenyatta National Hospital, P.O. Box 19676, Nairobi, Kenya
7Department of Medicine, University of Washington, Seattle, WA 98195, USA
8Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 50 Beale Street, Suite 1200, San Francisco, CA 94105, USA

Received 18 April 2011; Revised 6 June 2011; Accepted 8 June 2011

Academic Editor: Thomas Cherpes

Copyright © 2011 Nelly R. Mugo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Objective. To identify sensitive and specific histological criteria for endometritis in women with laparoscopically-confirmed acute salpingitis. Methods. Women, age 18–40 years of age presenting with complaints of lower abdominal pain ≤2 weeks and no antibiotics use in past two weeks, were enrolled. They underwent clinical examination, screening for HIV; other sexually transmitted infections plus endometrial biopsy sampling for histopathology. Diagnostic laparoscopy confirmed the diagnosis of acute salpingitis. Controls were women undergoing tubal ligation and HIV-1 infected women asymptomatic for genital tract infection. Results. Of 125 women with laparoscopically-confirmed salpingitis, 38% were HIV-1 seropositive. Nineteen HIV-1 negative controls were recruited. For the diagnosis of endometritis, ≥1 plasma cells (PC) and ≥3 polymorphonuclear lymphocytes (PMN) per HPF in the endometrium had a sensitivity of 74% for HIV-1-seropositive, 63% for HIV-1-seronegative women with a specificity of 75% and positive predictive value of 85% regardless of HIV-1-infection for predicting moderate to severe salpingitis. For HIV-1-seronegative women with mild salpingitis, ≥1 PC and ≥3 PMN had a sensitivity of 16% and a PPV of 57%. Conclusion. Endometrial histology, did not perform well as a surrogate marker for moderate to severe salpingitis, and failed as a surrogate marker for mild salpingitis.