Abstract

We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests. A total of 696 women with vaginal discharge were recruited, 119 of whom had clinical PID. Patients with trichomoniasis had a significantly higher risk of PID than did women without trichomoniasis (). PID was not associated with any of the otherPp.03 pathogens. When the patients were stratified according to HIV-1 status, the risk of PID in HIV-1–infected patients with T. vaginalis increased significantly (); no association was found in patients without HIV-Pp.002 1. T. vaginalis infection of the lower genital tract is associated with a clinical diagnosis of PID in HIV-1–infected women. Pelvic inflammatory disease (PID) is a condition in which there is infection of the reproductive tract of women above the internal os of the cervix. This has classically been associated with an ascending cervical