Microbiological Etiology and Behavioral Risk Factors in Verified Pelvic Inflammatory Disease: A Case-Control Study

Abstract

Background:
Pelvic inflammatory disease (PID) represents the leading cause of tubal-peritoneal infertility, ectopic pregnancy, and chronic pelvic pain syndrome in women of reproductive age.
Objectives: To characterize the socio-demographic, behavioral, and clinical risk factors alongside pathogen profiles in patients with verified PID.
Materials and methods: This case-control study evaluated 150 women with acute or acute-on-chronic PID (case group) and 150 healthy gynecological controls (control group). Polymerase chain reaction (PCR) testing for sexually transmitted infections (STIs) and multivariable logistic regression analysis of risk factors were performed.
Results: The predominant pathogens isolated were Chlamydia trachomatis (34.7%), Mycoplasma genitalium (18.0%), and Neisseria gonorrhoeae (12.7%); polymicrobial infection was identified in 38.0% of cases. Independent risk factors for PID included multiple sexual partners (> 2 in the preceding year; OR = 3.84; 95% CI: 2.10–7.02; p < 0.001), non-use of barrier contraception (OR = 2.91; p = 0.002), intrauterine device insertion within the preceding 6 weeks (OR = 4.15; p = 0.005), and a prior history of STIs (OR = 3.22; p = 0.001).
Conclusions: Sexually transmitted infections and unprotected intercourse remain primary modifiable risk factors for PID, highlighting the critical importance of early chlamydial screening and barrier contraception education.

Keywords:
Pelvic inflammatory disease; PID; Chlamydia trachomatis; sexually transmitted infections; risk factors; intrauterine device.