Actinomyces are part of the normal vaginal flora - however Actinomyces is rarely detected in the absence of intrauterine contraceptive devices (IUCDs) (1)
if actinomyces-like organisms (ALOs) and intrauterine contraceptive (IUC) device
If ALOs are identified and the woman presents with symptoms of pelvic pain, then removal of IUC may be considered. Treatment involves high-does antibiotics for at least 8 weeks and health professionals should consult with a microbiologist. Other more common causes of pain (including STIs) should be excluded
has been suggested that asymptomatic women with positive ALOs on a cervical smear are more likely to be colonised by ALOs than infected, with the IUD potentially providing a good surface for the development of biofilm in vivo
there is no need to remove IUC in asymptomatic women with ALOs
for women who require a replacement device but have ALOs identified there is some evidence to suggest that immediate reinsertion or a short delay of 3-5 days is safe
insertion or reinsertion of an intrauterine method can be carried out in asymptomatic women with ALOs (3)
there is no need to remove IUC in asymptomatic women with ALOs (3)
if asymptomatic then (5):
coil does not need to be removed and antibiotics are not required
patient should have an abdominal and pelvic examination
patient should be warned of the small possibility of developing pelvic actinomycosis and advised to return should she develop symptoms
family planning follow-up should be arranged every six months and should include enquiry regarding new symptoms and a pelvic examination
repeat cytology is not required unless the smear was graded inadequate/abnormal i
f the asymptomatic patient wishes the device to be removed or it is due for removal then it need not be sent for culture.
Notes:
actinomyces israelii is a commensal of the female genital tract.
Actinomyces-like organisms (ALOs) have been identified in women with and without IUC - although it is acknowledged that the level is thought to be low and that actinomycosis is rare
role of ALOs in infection in women using IUC is unclear
Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.