All antibiotic regimens must be effective against C trachomatis and N gonorrhoeae, as well as against gram-negative facultative organisms, anaerobes, and streptococci. Alterations in the cervicovaginal microenvironment may also result from antibiotic treatment and sexually transmitted vaginal infections that can disrupt the balance of endogenous flora, causing normally nonpathogenic organisms to overgrow and ascend. Opening of the cervix during menstruation with retrograde menstrual flow may also facilitate ascent of microorganisms.
An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present. In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a surgical procedure in which a thin, rigid tube with a lighted end and camera (laparoscope) is inserted through a small incision in the abdomen.

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