Re: actinomycosis in IUD
From: Efrain Ramirez (eramirezt@coqui.net)
Tue Oct 21 19:09:59 2003
I would obviate HSG.
>At Tue, 21 Oct 2003, Richard Chudacoff, MD wrote:
>
>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.
>
--
"The opposite of a correct statement is a false statement.
But the opposite of a profound truth may well be another profound truth."
Niels Bohr (1885 - 1962)
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