The incidence of acute salpingitis which are only one aspect of pelvic inflammatory disease has decreased during the last 20 years and more and more patients have mild symptoms. Consequences of this evolution are uncertainty for the diagnosis without laparoscopic proof of the pelvic inflammatory disease, ambulatory treatment with inappropriate regimen increasing the risk of chronical disease and long term sequelae. So laparoscopy must remain a standard in diagnosis and treatment especially in young childless women. Follow up of the medical treatment is necessary to assess its effectiveness and its compliance, to treat the sexual partner, and to provide informations about preventive measures to avoid relaps.