Management

Consult local microbiology specialist for guidance regarding management.

If actinomyces-like organism (ALOs) on cervical smear and woman has an intrauterine contraceptive device (1):

• 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
    
    
  • there is no need to remove IUC in asymptomatic women with ALOs.

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
  • there is no evidence as to whether or not an IUD should be inserted in women who have ALOs identified prior to IUD use
    

Reference:

• FSRH Guidance (April 2015) Intrauterine Contraception
• CKS. Contraception - IUS/IUD (Accessed 23/7/19)