Acute pelvic pain in women: rule out pregnancy, look for pelvic inflammatory disease

Laboratory tests

• hCG (immediate urine test or serum β-hCG)
• Positive hCG: see the page "Bleeding or pelvic pain in early pregnancy" (ectopic pregnancy).
• HIV serology
• Syphilis serology
• FBCif neededTo judge severity: a raised CRP supports the diagnosis but is not specific, and CRP as well as leucocytes are often normal in mild or moderate forms ^[2]; normal values do not exclude upper genital tract infection. The CNGOF and SPILF advise FBC and CRP for any suspected upper genital tract infection (grade C): leucocytosis and raised CRP suggest a complicated form or another diagnosis, such as appendicitis ^[3].
• CRPif neededTo judge severity: a raised CRP supports the diagnosis but is not specific, and CRP as well as leucocytes are often normal in mild or moderate forms ^[2]; normal values do not exclude upper genital tract infection. The CNGOF and SPILF advise FBC and CRP for any suspected upper genital tract infection (grade C): leucocytosis and raised CRP suggest a complicated form or another diagnosis, such as appendicitis ^[3].

Speculum sample (endocervix; vaginal failing that)

• Endocervical sample: direct examination, culture (including gonococcus) with susceptibility testing
• Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR) (endocervix)
• Mycoplasma genitalium NAAT (PCR) (multiplex Chlamydia, gonococcus and M. genitalium, in place of the previous one)if neededRecommended for any suspected upper genital tract infection ^[2,4]. The NABM reimburses multiplex PCR only in case of observed acute cervicitis (or urethritis, or an infected partner) ^[5]: without cervicitis, write NR (not reimbursable).
• Hepatitis B serology (HBsAg, anti-HBs, anti-HBc), if status unknownif neededConfirmed or suspected STI, vaccination status unknown: screening for other STIs, including hepatitis B (see the page "Sexually transmitted infections").

Urine tests

• Urine dipstick (if urinary signs, to rule out urinary infection)if needednon-French guidelineDysuria or frequency: urinary tract infection is part of the differential diagnosis in the UK and the Netherlands ^[6,7]. Australia does urine tests for any recent pelvic pain in a woman of childbearing potential ^[8], and an American Family Physician review proposes considering it ^[9]. The French recommendation asks to look for urinary signs on history, without providing for a urine test ^[3].

3 to 6 months after treatment

• Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR) on a vaginal sample, self-sampling possible (upper genital tract infection associated with an STI)
• Earlier follow-up only if symptoms persist, if adherence was poor or if a partner was not treated.