HSV-2 Infection May Raise Risk for Pelvic Inflammatory Disease


WASHINGTON — Herpes simplex virus type 2 infection in women may be associated with an increased risk of pelvic inflammatory disease, Dr. Thomas L. Cherpes reported in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

The role of chronic genital viral infections in the pathogenesis of pelvic inflammatory disease (PID) may be more significant than currently recognized, although no etiologic link has as yet been defined, noted Dr. Cherpes and his associates at the University of Pittsburgh.

A total of 725 nonpregnant women aged 15–30 years who were either diagnosed with a lower bacterial genital tract infection (purulent cervical discharge, untreated Neisseria gonorrhoeae or Chlamydia trachomatis infection, symptomatic bacterial vaginosis) or were at risk for such an infection (sexual contact with a male diagnosed with gonorrheal, chlamydial, or nongonococcal urethritis) were recruited from sexually transmitted disease clinics and gynecology clinics. Of those, 43% (309) were seropositive for herpes simplex virus type 2 (HSV-2).

Of the 86 women with acute endometritis, 55% (47) were HSV-2 seropositive, as were 51% (70) of the 136 women found to have plasma cell endometritis. Acute endometritis was independently associated with black race (odds ratio 1.7) as well as infections with C. trachomatis (3.3), N. gonorrhoeae (2.8), Trichomonas vaginalis (2.4), and HSV-2 (2.2). Black race also was associated with plasma cell endometritis (odds ratio 1.9), but HSV-2 was the only reproductive tract infection significantly associated with that condition (odds ratio 1.5), they reported.

Coinfection with HSV-2 and a genital tract bacterial pathogen significantly increased the likelihood of PID, compared with having one or the other alone. For example, the odds ratio for acute endometritis was 5.0 for women with chlamydia and 2.6 for those with HSV-2, compared with women who did not have those conditions. However, the odds ratio jumped to 7.3 for women coinfected with both. Similarly, women with gonorrhea alone had a 4.2-fold increased risk for acute endometritis, which rose to 6.0 if they were also infected with HSV-2.

Among 471 of the women who underwent hysterosalpingography, 8.1% (38) had both HSV-2 infection and evidence of fallopian tube obstruction: Those 38 women accounted for 19% of the 199 women who were HSV-2 positive and 54% of the 71 with fallopian tube blockage.

Of course, these data do not exclude the possibility that the higher prevalence of HSV-2 among women with PID may simply reflect a marker for sexual activity and/or the coacquisition of a PID-associated bacterial pathogen.

However, “as PID remains the most frequent gynecologic cause for emergency room visits as well as the most frequent infectious cause of infertility, confirmation and further exploration of these findings could have important clinical implications,” Dr. Cherpes and his associates wrote.

The conference was sponsored by the American Society for Microbiology.

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