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

Abstract EN

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.