**2. Epidemiology**

Approximately 35% of women with an infertility problem are afflicted with post-inflammatory changes of the oviduct or surrounding peritoneum that interfere with tubo-ovarian function. Most of these alterations result from infection. Salpingitis occurs in an estimated 15% of reproductive-age women, and 2.5% of all women become infertile as a result of salpingitis by age 35.[2] Because in most cases, especially those caused by *Chlamydia trachomatis*, signs and symptoms are often minimal or non-existent, the actual percentage of women with upper genital tract infections is probably underestimated.

Unfortunately, the impact of infectious sequelae on human reproduction continues to increase as a consequence of sexual promiscuity and the popularity of non-barrier methods of contra‐ ception. *C. trachomatis* and gonorrheal infections, as well as mixed anaerobic infections, are the most prevalent causes of upper genital tract infections resulting in pelvic inflammatory disease (PID). Bacterial vaginosis, *Trichomonas vaginalis*, and *Candida albicans* are the most prevalent bacterial, protozoan, and fungal causes of lower genital tract infections. Although gonorrheal infections have been on the decline in the last decade, chlamydial infections of the male and female genital tract continue to be an increasing problem, and *C. trachomatis* is the major cause of tubal factor infertility.[3] *C. trachomatis* is usually recovered three to five times more frequently than *Neisseria gonorrhoeae* from the reproductive tracts of infected individuals.

Women are twice as likely as men to acquire gonorrhea or *Chlamydia* during a single act of unprotected intercourse with an infected partner. Many newly infected women have no symptoms and so do not seek medical intervention and continue to spread the infection to other sexual partners. An estimated 10% to 20% of untreated women with endocervical gonorrhea or chlamydial infection eventually develop salpingitis.[4] Scholes et al[5] recom‐ mended routine testing of sexually active women to prevent sequelae like pelvic inflammatory disease and consequently infertility. Despite the current focus on sexually transmitted diseases (STDs), infertility may also follow blood-borne infections such as tuberculosis, mixed aerobic and anaerobic infections of other pelvic sites, inflammatory complications of surgical trauma, post-abortal and puerperal sepsis, and appendicular rupture.
