More than 1 million women in the United States are reported to have pelvic inflammatory disease (PID). Of these women, 70% are under 25 years of age. Many cases go unreported and often are unrecognized, especially in 11- to 15-year-old adolescents. The presentation of PID can be a diagnostic challenge for the clinician. Many clinicians assert that a diagnosis of PID in an adolescent is an indication for hospitalization, simply because of the high rate of noncompliance with a two-drug regimen in this age group. However, many health care plans no longer support hospitalization for uncomplicated PID. This article presents an overview of the risk factors, range of presenting symptoms, diagnostic methods, and criteria. Treatment and follow-up guidelines are discussed, along with issues related to patient compliance with various regimens. A sample contract for use with adolescent clients in an attempt to improve compliance is also provided. The article includes case studies that typify common presentations.