management
Last edited 07/2019
Consult local microbiology specialist for guidance regarding management.
If actinomyces-like organism (ALOs) on cervical smear and woman has an intrauterine contraceptive device (1):
- If ALOs are identified and the woman presents with symptoms of pelvic pain,
then removal of IUC may be considered. Treatment involves high-does antibiotics
for at least 8 weeks and health professionals should consult with a microbiologist.
Other more common causes of pain (including STIs) should be excluded
- has been suggested that asymptomatic women with positive ALOs on a
cervical smear are more likely to be colonised by ALOs than infected,
with the IUD potentially providing a good surface for the development
of biofilm in vivo
- there is no need to remove IUC in asymptomatic women with ALOs
- for women who require a replacement device but have ALOs identified
there is some evidence to suggest that immediate reinsertion or a short
delay of 3-5 days is safe
- insertion or reinsertion of an intrauterine method can be carried
out in asymptomatic women with ALOs
- there is no need to remove IUC in asymptomatic women with ALOs.
- has been suggested that asymptomatic women with positive ALOs on a
cervical smear are more likely to be colonised by ALOs than infected,
with the IUD potentially providing a good surface for the development
of biofilm in vivo
Notes:
- actinomyces israelii is a commensal of the female genital tract.
- Actinomyces-like organisms (ALOs) have been identified in women with and without IUC - although it is acknowledged that the level is thought to be low and that actinomycosis is rare
- role of ALOs in infection in women using IUC is unclear
- there is no evidence as to whether or not an IUD should be inserted
in women who have ALOs identified prior to IUD use
Reference:
- FSRH Guidance (April 2015) Intrauterine Contraception
- CKS. Contraception - IUS/IUD (Accessed 23/7/19)