Michelle complains of a lower abdominal pain for the last two or three days. She is 23-years-old, living with James, is well known to you and you know she has had several boyfriends. Michelle and James have used no contraception for the last eight months and her last normal period was six weeks ago. Since then Michelle has had some spotting.

On examination, she is normotensive but has lower abdominal tenderness. On pelvic examination the cervix was closed, the uterus was slightly tender. The left fornix was also a little tender.