Limited Role of Mycoplasma genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae in Pelvic Inflammatory Disease and Tubo-Ovarian Abscess in the Netherlands: A Multicenter Prospective Cohort Study.

OBJECTIVE: To evaluate the role of Mycoplasma genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae in pelvic inflammatory disease (PID) and tubo-ovarian abscess (TOA), and to assess the effectiveness of standard therapy in achieving clinical and microbiological cure. DESIGN: Multicenter prospective cohort study. SETTING: Three hospitals and one Centre for Sexual Health (CSH) in the Netherlands. POPULATION: Women ≥ 18 years with clinically diagnosed PID and/or TOA between 2021 and 2023. METHODS: Clinical examination, C-reactive protein (CRP) levels, and vaginal swabs were evaluated at baseline and follow-up. Participants completed a self-reported symptom diary. Antibiotic therapy was prescribed in accordance with Dutch national hospital and CSH guidelines. MAIN OUTCOME MEASURES: The primary outcome, clinical cure at Week 4, was defined as the absence of fever and vomiting, CRP < 10 mg/L, and ≥ 70% reduction in symptom score. Microbiological cure was the secondary outcome. RESULTS: Among 100 women with PID and/or TOA, monoinfections with M. genitalium, C. trachomatis, and N. gonorrhoeae were detected in 4.0%, 6.0%, and 9.0% of cases, respectively; coinfections occurred in 4.0%, while 77.0% tested negative for all three pathogens. By Week 4, M. genitalium and C. trachomatis were cleared, with one case of persistent or recurrent N. gonorrhoeae. Symptom scores declined by 91.3%, with significant CRP reduction. Clinical cure was achieved in 67.3% of participants, with no association between cure and sexually transmitted infection (STI) status or diagnosis. CONCLUSIONS: Most PID and/or TOA cases lacked an identifiable STI etiology. Nonetheless, the majority showed clinical and microbiological cure, supporting current empiric treatment.