Review symptoms: pelvic pain, abnormal vaginal discharge, fever, pain during sex, painful urination, irregular bleeding
Take a sexual history and assess STI risk
Perform a pelvic exam for cervical motion tenderness, uterine tenderness, or adnexal tenderness
Test for gonorrhea and chlamydia with NAAT
Test for other STIs as indicated, including HIV and syphilis
Check pregnancy test to rule out ectopic pregnancy
Obtain urinalysis to assess for urinary tract infection
Consider vaginal/cervical swabs for wet mount, pH, and microscopy
Consider inflammatory markers such as CBC or CRP if needed
Use pelvic ultrasound if tubo-ovarian abscess or alternative diagnosis is suspected
Consider laparoscopy if diagnosis remains uncertain or severe disease is suspected
Diagnose clinically when pelvic pain is present with no better explanation and at least one of cervical motion tenderness, uterine tenderness, or adnexal tenderness is found