Abstract Title: The Hidden Threat: Understanding the Significance of Tubo-Ovarian Abscess in Women’s Health Background: A tubo-ovarian abscess (TOA) is a serious and potentially life-threatening inflammatory mass involving the fallopian tube, ovary, and other pelvic organs, often resulting from a pelvic inflammatory disease (PID). TOAs are more often caused by Escherichia coli, aerobic streptococci, Bacteroides fragilis, and Actinomyces israelii, while Neisseria gonorrhoeae and Chlamydia trachomatis are rarely found from within the abscess cavity. The signs and symptoms can present as an ectopic pregnancy, appendicitis, or ovarian torsion. Aggressive medical or surgical treatment is often required to prevent rupture and/or sepsis. This infection typically occurs in sexually active women, particularly those with a history of STIs, intrauterine device use, or PID. Case Presentation: A 37-year-old female patient, with a history of spontaneous abortions and dyspareunia, presented to the ED with right lower quadrant (RLQ) pain for three days and was diagnosed with COVID-19 on arrival. Her last menstrual period was one month ago, and she denies history of any STI or PID. The pain came on suddenly, was constant, stabbing in nature, rated as 10/10, mostly in the RLQ radiating to the back. She tried over-the-counter pain medications without any relief. Laying still makes the pain tolerable, but movement makes it worse. She also described having a mild burning sensation with urination for the past three days, but denied any blood in the urine, changes in frequency, urgency, vaginal discharge or odor. A pelvic ultrasound showed bilateral hemorrhagic ovarian cysts with a recent rupture. Further imaging via CT showed concern for tubo-ovarian abscesses given associated hydrosalpinx. She was started on vancomycin, but she experienced a systemic reaction, prompting a switch to ceftriaxone and meropenem. She went into an emergent exploratory laparotomy with a right salpingo-oophorectomy and drainage of a left TOA. Low molecular weight heparin was started for anticoagulation and antibiotics were continued. Neisseria gonorrhoeae was identified in the peritoneal pus as the causative organism. The patient was afebrile, hemodynamically stable, and discharged after five days with a prescription for levofloxacin and metronidazole for outpatient treatment. At the two-week follow-up, the surgical scar healed well, and the antibiotics were completed with no onset of new symptoms. Conclusion: This case highlights the importance of thorough evaluation and multidisciplinary management involving hospitalists, ED physicians, and gynecologists in managing TOAs. Identifying the causative organism is crucial for targeted antibiotic coverage, preventing surgical site infections, and addressing potential bacterial growth. TOA cases can vary and considered in differential diagnoses.