Objective: To explore the risk of pelvic inflammatory disease (PID) associated with chlamydia and gonorrhea infection and subsequent repeat infections, which provides theoretical basis for clinical prevention and treatment. Methods: A total of 315 123 women, born from 1978–1999, were probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2007 to 2017. Statistical analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID. Results: A total of 120 748 women had pathology test records for both chlamydia and gonorrhea, 10 745 chlamydia only, and 653 gonorrhea only. Among those tested, 16 778 (12.8%) had positive chlamydia test, 3 195 (2.6%) were positive gonorrhea test, and 1 874 (1.6%) were positive for both. There were 4 819 PID presentations (2 222 hospitalizations, 2 597 emergency presentations). Adjusting for age, aboriginality, health area, and socioeconomic status, compared to women negative for chlamydia and gonorrhea, the relative risk (adjusted incidence rate ratio) of PID was 4.29 (95% CI 3.66–5.03) in women who were both chlamydia and gonorrhea positive; 4.54 (95% CI 3.87–5.33) in those only gonorrhea positive; and 1.77 (95% CI 1.61–1.94) in those only chlamydia positive. Conclusion: Gonorrhea infection confers a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID.