Pelvic inflammatory disease is a common cause of morbidity in young sexually active women, but many of our preventive efforts and management strategies are based on empirical approaches. Central to the implementation of chlamydia screening programmes is an understanding of the risk of PID following chlamydial infection. The recent POPI study helps to inform this risk and also provides information about the role of other potential pathogens. The importance of Mycoplasma genitalium as a cause of PID needs to be clarified, but its implications for testing and treatment are now becoming clearer. Women with PID are often poorly adherent to antimicrobial treatment and recent trials suggest that newer treatment regimens may be easier to take and have the potential to improve outcomes.