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Re: ActinomycesFrom: Efrain Ramirez (eramirezt@coqui.net)Fri Mar 10 14:00:40 2006
CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN—GYNECOLOGISTS NUMBER 59, JANUARY 2005 What treatment options are appropriate for an asymptomatic patient with an IUD who has actinomyces identified on a Pap test? Actinomyces israelii, a gram-positive anaerobic bacterium normally found in the human gastrointestinal tract, may be a normal component of vaginal flora. This organism may be more prevalent in the genital tract of IUD users than in nonusers. The likelihood of colonization appears to increase with increasing duration of IUD use (41). Recent studies demonstrated that colonization may be lower in levonorgestrel intrauterine system users than in copper IUD users (2.9% versus 5–10%) (41–43). However, actinomyces found via a Pap test is not diagnostic of actinomycosis infection, nor is it predictive of future disease. Pelvic actinomycosis is a very rare but serious condition characterized by granulomatous pelvic abscesses. Its prevalence has been estimated to be less than 0.001%; because of its rarity, the relationship between actinomyces found on a Pap test in an asymptomatic IUD user and the eventual development of this infection is unclear. Studies of pelvic actinomycosis are limited to case reports, so management of the asymptomatic IUD user whose Pap test shows actinomyces is not clearly established. A recent review of pelvic actinomycosis underlines the ubiquity of Actinomyces israelii in both IUD users and nonusers and the lack of an association between the finding of this organism on a Pap test and adverse outcomes when no treatment is offered (44). A single randomized controlled trial has looked at management of asymptomatic IUD users with actinomyces identified on a Pap test (45). Women were randomized to undergo either removal of the IUD and receive oral antibiotics or receive oral antibiotics alone. One month after treatment, the Pap test was repeated. No Pap tests revealed actinomyces in the women whose IUDs were removed. Thirty-three percent of Pap tests still showed actinomyces in the group of women who received antibiotics alone. However, the importance of clearing the actinomyces colonization is still not established. The options for management of asymptomatic IUD users with actinomyces on Pap test are expectant management, an extended course of oral antibiotics, removal of the IUD, and both antibiotic use and IUD removal. It's a toss-up - I would tell her this information - if she has no children my gut feeling would be to take it out and give antibiotics - in my setting I would at least give her antibiotics - but the final decision will be hers.. Good luck -- Ef
>At Fri, 10 Mar 2006, Rafael Haciski wrote:
-- “ The greatest obstacle to knowledge is not ignorance, it is the illusion of knowledge.” Daniel J. Boorstin - Historian
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