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Contraception - Management
How should I manage a woman who has actinomyces-like organisms on a cervical smear and is using a copper intrauterine device (IUD)?

  • If a woman who is using the copper intrauterine device (IUD) has actinomyces-like organisms in a cervical smear:
    • Assess her for signs and symptoms of pelvic inflammatory disease:
      • Lower abdominal pain and tenderness (usually the most prominent symptom).
      • Dyspareunia.
      • Abnormal vaginal bleeding (e.g. menorrhagia, postcoital or intermenstrual bleeding).
      • Abnormal vaginal discharge.
      • Dysuria (pelvic inflammatory disease can occur with concurrent urethral chlamydial infection).
      • Nausea and vomiting (rare other than in acute infection).
    • If the woman is asymptomatic:
      • Advise her that it is not necessary to remove the copper IUD unless signs or symptoms of infection occur.
    • If the woman has symptoms of pelvic inflammatory disease:
      • There is probably no need to remove the copper IUD.
      • Consider investigating and treating her. See the CKS topic on Pelvic inflammatory disease.
      • If in doubt, consult a contraception specialist or refer the woman to a genito-urinary clinic or a gynaecology clinic.
Clarification / Additional information
    • Actinomyces israelii are commensals of the female genital tract. They may be identified on cervical smears, but this is not diagnostic or predictive of any disease.
    • Actinomyces-like organisms (ALOs) are found in women with and those without a copper intrauterine device (IUD).
      • The role of ALOs in infection in copper IUD users is unclear.
      • Limited evidence suggests that the copper IUD should be removed in a symptomatic woman, with appropriate antibiotic treatment provided and referral to a genito-urinary or gynaecology clinic.
    • Previously, it was recommended that women with ALOs retaining their IUDs should be followed up every 6 months. However, evidence indicates that routine follow-up of asymptomatic women may not be necessary:
Basis for recommendation
  • These recommendations are based on guidance issued by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2004a].

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