Identification of Microbes Associated with Pelvic Inflammatory Disease and Infertility

Pelvic inflammatory disease (PID) is an important cause of female reproductive morbidity and infertility. Sexually transmitted infections and vaginal microbial dysbiosis may contribute to reproductive tract inflammation and impaired fertility. Objective: To identify microorganisms associated with PID and evaluate their relationship with infertility among reproductive-age women. Methods: This comparative cross-sectional study was conducted at Maryam Nawaz Health Clinic, Nat Klan, Wazirabad, from June 2025 to May 2026. A total of 60 women diagnosed with PID were included, comprising 30 with infertility and 30 without infertility. Sexually transmitted microorganisms were detected using nucleic acid amplification tests (NAATs), while bacterial vaginosis was assessed using Nugent scoring. Associations with infertility were evaluated using odds ratios, Fisher’s exact test, and exploratory multivariable logistic regression. Results: The mean age was 30.2 ± 4.3 years. Mycoplasma genitalium was the most frequently detected sexually transmitted microorganism (13.3%), followed by Chlamydia trachomatis (8.3%), Trichomonas vaginalis (6.7%), and Neisseria gonorrhoeae (3.3%). Bacterial vaginosis was identified in 43.3% of participants. STI positivity was significantly higher among infertile women than non-infertile women (40.0% vs. 13.3%; OR=4.33; p=0.039), as was bacterial vaginosis (60.0% vs. 26.7%; OR=4.13; p=0.018). Detection of either STI microorganisms or bacterial vaginosis was associated with infertility (OR=5.50; 95% CI: 1.81–16.68; p=0.004). However, these associations remained inconclusive after multivariable adjustment. Conclusion: Sexually transmitted microorganisms and bacterial vaginosis were more frequently detected among women with PID-associated infertility. These findings support comprehensive microbiological assessment, although larger prospective studies are required to establish independent associations.