The importance of the removal of the intrauterine device in genital colonization by Actinomyces

Objective: To determine whether, in addition to treatment with antibiotics, it is necessary to remove the intrauterine device (IUD) to eliminate genit al colonization by Actinomyces. Methods: A randomized clinical trial was ca rried out. Patients were divided into two groups. The intervention group di d not have their IUDs removed, while the control group did. Both groups wer e treated with trimethoprim and sulfamethoxazole. A total of 43 patients we re included. Results: The patients from the intervention group and the cont rol group proved to be comparable. The post-intervention cytology smear tes ted negative for Actinomyces in 100% of the patients whose IUD had been rem oved and in 66.7% of those whose IUD had not been removed (p = 0.005). The probability that colonization by Actinomyces will continue if the IUD is no t removed is greater the longer the patient has been exposed to the IUD. Af ter 24 months, relative risk (RR) = 2, after 36 months RR = 2.16 and after 48 months RR = 2.66. Conclusions: The removal of the IUD has been effective in genital colonization by Actinomyces. The protective effect exerted by t he removal of the IUD was found to be greater in proportion to the length o f time the patient had used it. Copyright (C) 2001 S. Karger AG, Basel.