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Re: actinomycosis in IUDFrom: Braun, R. Daniel (rbraun@iupui.edu)Tue Oct 21 11:10:44 2003
"Moot" I hope. Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD Sent: Tuesday, October 21, 2003 8:59 AM To: Multiple recipients of list OB-GYN-L Subject: Re: actinomycosis in IUD Treat with or without the IUD in place? Actually, mute point. I just talked to the patient. The plan will be to remove the IUS, treat for 6 months on PCN. I plan to perform an HSG at the end of the six-month period, just to document the patency of the uterus and tubes. Most of this is CYA. 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 DoctorJoe@aol.com Sent: Monday, October 20, 2003 11:10 PM To: Multiple recipients of list OB-GYN-L Subject: Re: actinomycosis in IUD In a message dated 10/20/03 5:53:19 PM, 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. >> Looks like asymptomatic colonization, which is common with IUDs. But the mass of bugs might be worrisome. It would be prudent to treat for 6 weeks or so with an appropriate antibiotic for Actino. It might be interesting to see if the uterine symptoms abate. As far as scoping someone with no tenderness and no complaints (i.e. of infertility), I think I'd pass and just treat with antibiotics. Joe P.
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