title: Comparison of two procedures for routine IUD exchange in women with positive Pap smears for actinomyces-like organisms.
abstract: BACKGROUND
  In the female genital tract, up to 30% of Papanicolaou (Pap)-stained cervicovaginal smears of intrauterine device (IUD) users are positive for actinomyces-like organisms (ALOs). Many clinicians believe that no therapeutic intervention is necessary if women with ALOs are without symptoms. However, there are no recommendations for the procedure in ALO-positive women with need for a routine IUD exchange.
  
  
  METHODS
  In this retrospective study, the incidence of ALOs was compared in ALO-positive women with a routine IUD exchange according to two new procedures: Group 1 (n=19), insertion of a new IUD immediately after removal of the index device, and Group 2 (n=19) IUD removal and reinsertion after 3-5 days. A Pap smear was obtained at intervals of 6 weeks and 12, 24 and 36 months after reinsertion.
  
  
  RESULTS
  The cytological examination carried out after 6 weeks proved to be negative for ALOs in all cases. After 36 months, smears were more often positive for ALOs in women with immediate IUD exchange (73% vs. 33%; p<.17).
  
  
  CONCLUSIONS
  Our results indicate that in ALO-positive women, IUD reinsertion immediately after removal or after an interval of 3-5 days is safe. The interval reinsertion might be of advantage on a long-term basis.
authors.affiliation: Clinic for Reproductive Endocrinology, Department of Gynaecology and Obstetrics, University Hospital, CH-8091 Zürich, Switzerland. gabriele.merki@usz.ch
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Merki-Feld
authors.forename: Marinella
authors.initials: M
authors.lastname: Rosselli
authors.forename: Bruno
authors.initials: B
authors.lastname: Imthurn
mesh_terms: D000190:Actinomyces / Q000302:isolation & purification*; D000196:Actinomycosis / Q000382:microbiology* / Q000517:prevention & control*; D000328:Adult; D002584:Cervix Uteri / Q000382:microbiology; D005260:Female; D006801:Humans; D007434:Intrauterine Devices / Q000009:adverse effects*; D008875:Middle Aged; D065006:Papanicolaou Test; D012189:Retrospective Studies; D013997:Time Factors; D014626:Vaginal Smears