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Re: actinomycosis in IUDFrom: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com)Tue Oct 21 08:48:05 2003
Except all the literature supports removing the IUD, most of that comes with grossly symptomatic patients. One benefit is the patients desire for infertility, and the fact that I did not put the first one in the nulliparous patient. However, that old cowboy wisdom of stopping the digging when you know you’re in a hole comes to mind. I’d rather pull the IUS and do a BTL than leave it in place. Richard Chudacoff, MD Never let your sense of morals prevent you from doing what's right. Isaac Asimov -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of RModugno@aol.com Sent: Monday, October 20, 2003 8:56 PM To: Multiple recipients of list OB-GYN-L Subject: Re: actinomycosis in IUD In a message dated 10/20/2003 6:53:19 PM Eastern Standard Time, rchudacoff@mylinuxisp.com writes: Replaced a copper T IUD with a Mirena progesterone intrauterine system IUD last week and today I received a call from the pathologist that the copper IUD was ‘ as covered with actinomyces’ as he had ever seen. Needless to say, the Mirena comes out as soon as I can get a hold of her, but do I still need to treat her for 6-12 months in an asymptomatic infection? Do I need to scope her to rule out PID if there is no pain? She really expressed the desire for permanent infertility, even though she is a 27 year old nullipara. I should say that she is not entirely asymptomatic. I replaced the IUD with the IUS because of dysmenorrhea and menorrhagia. There is no dyspareunia, nor tenderness on bimanual exam. Call me crazy, but I'm not 100% sure you need to remove the new IUD.Laparoscopy certainly is not indicated.You may want to treat her prophylactically eith antibiotics, or repeat a smear/culture in 6weeks. My 2 cents. Robert Modugno MD MBA FACOG marietta, GA www.novaobgyn.yourmd.com <http://www.novaobgyn.yourmd.com>
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