Pelvic inflammatory disease (PID) is common infection among reproductive-aged women. The presentation ranges from acute severe illness to a more indolent and mild clinical picture. Attention has turned to subclinical PID as an important entity. The majority of the public health impact from PID comes from its attributable long-term sequelae, including tubal-factor infertility, ectopic pregnancy, and chronic pelvic pain. Tubo-ovarian abscess (TOA) represents a severe form of PID. Vigilance is required when caring for women who have PID to detect the presence of a TOA given the serious nature of the infection and the potential need for procedural intervention.