Asymptomatic Genitourinary Chlamydia Trachomatis Infection in Women Seropositive for Human Immunodeficiency Virus Infection

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Abstract
Objective: To evaluate the prevalence of asymptomaticChlamydia trachomatisgenitourinary infection in women with human immunodeficiency virus (HIV) infection. Methods: The prevalence of asymptomatic chlamydial genitourinary infection in HIV-seropositive women was compared with both HIV-seronegative controls and women with unknown HIV status.Chlamydia trachomatiswas isolated in cell culture from endocervical and urethral specimens. Results: The prevalence of genitourinaryC trachomatisinfection among HIV-seropositive women was 18.3% (21 of 115), a rate significantly higher than in both HIV-negative women (11 of 136;P= .016) and controls with unknown HIV status (18 of 326;P= .0001). Crude odds ratios for endocervical and urethral chlamydial infection in HIV-seropositive women compared to HIV-seronegative controls were 2.6 (95% confidence interval [CI] 1.13-6.08) and 3.3 (95% CI 1.15-9.67), respectively. After adjustment for variables related to sexual habits, there was no difference in the risk of cervicalC trachomatisinfection between HIV-seropositive cases and HIV-seronegative controls (Mantel-Haenszel odds ratio 1.04, 95% CI 0.93-1.14;P= .41). Finally, in HIV-seropositive patients, both the severity of immunosuppression evaluated by CD4+, CD8+, and total lymphocyte counts and the detection of p24 HIV-related antigen did not correlate with the presence of chlamydial infection. Conclusions: Women infected with HIV are at high risk for asymptomatic genitourinary chlamydial colonization. To prevent a possible “epidemic” of pelvic inflammatory disease, appropriate screening programs and therapeutic strategies should be planned.(Obstet Gynecol 1994;83:1005-10)

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