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.