Pelvic inflammatory disease Quiz: Ace Your Exams

A 25-year-old woman is brought by ambulance to the emergency department for evaluation of altered mental status and abdominal and pelvic pain. The patient’s mother arrived at the patient’s house and found her in pain and confused. The patient was recently diagnosed with a sexually transmitted infection and started on oral antibiotics. She has no significant past medical history and takes no daily medications. Temperature is 39°C (102°F), blood pressure is 86/50 mmHg, pulse is 122/min, respiratory rate is 22/min, and oxygen saturation is 98% on room air. The patient appears ill and is confused. Physical examination reveals lower abdominal tenderness with guarding and rebound. Pelvic examination demonstrates bilateral adnexal tenderness to palpation, cervical motion tenderness, and mucopurulent cervical discharge. White blood cell count shows leukocytosis.  ESR and CRP are elevated. The patient is started on empiric antibiotics and intravenous fluids. Labs are ordered and pending. Urine HCG is negative for pregnancy. Which of the following is the best next step in management?