Re: actinomycosis in IUD
From: art fougner, md (evsono@pipeline.com)
Tue Oct 21 21:36:48 2003
unless the patient already has a subclinical infection which is worsened
by the procedure.
art
At Tue, 21 Oct 2003, Richard Chudacoff, MD wrote:
>
>I think, like a c-section, it could only harm me if it was NOT done.
>
>--
>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 Efrain
>Ramirez
>Sent: Tuesday, October 21, 2003 7:11 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: actinomycosis in IUD
>
>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)
>
--
art fougner, md
ich bin ein New Yorker
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