The putative role of nongonococcal nonchlamydial bacteria, especially anaerobes and more recently M. genitalium, in the pathogenesis of acute PID and whether antimicrobial regimens for treatment of PID should provide coverage against these microorganisms is more controversial. Some propose that anaerobic coverage is only required in patients with severe PID [2], especially those with tuboovarian abscesses. Others suggest that anaerobic coverage should be provided to all women with acute PID [1]. Clearly anaerobic bacteria have been demonstrated in the upper genital tract of women with acute PID with anaerobic bacteria recovered from the upper genital tract in 13% to 78% of women with PID [28–35]. In addition, anaerobes (e.g., Bacteroides fragilis) have caused tubal damage in vitro studies [1].