--
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 Braun, R.
Daniel
Sent: Tuesday, October 21, 2003 11:13 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: actinomycosis in IUD
"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.
