25 year old woman with IUD inserted 2 years ago presents with fever. On examination, actinomyces is positive in cervical cytology. What would you advise regarding IUD?
## **Core Concept**
The presence of *Actinomyces* in cervical cytology, particularly in a patient with an intrauterine device (IUD) in place, suggests a condition known as actinomyces infection or actinomycosis, which is a type of bacterial infection caused by *Actinomyces* species. This condition is associated with the use of IUDs, especially if the device has been in place for an extended period.
## **Why the Correct Answer is Right**
The correct approach in managing a patient with an IUD in place and evidence of *Actinomyces* infection is to remove the IUD. This is because the IUD can act as a nidus or a foreign body that supports the growth of *Actinomyces*, making it difficult to treat the infection effectively without removing the source. Antibiotics are typically used to treat the infection, but removal of the IUD is often necessary to ensure resolution of the infection.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because simply leaving the IUD in place and prescribing antibiotics might not be sufficient to clear the infection, as the IUD can continue to act as a source of infection.
- **Option B:** This option is incorrect because while antibiotics are a crucial part of treating actinomycosis, they alone might not be enough if the IUD is not removed, as explained.
- **Option C:** This option is incorrect because there is no standard recommendation for replacing the IUD with a new one immediately in the setting of an active infection; the focus should be on treating the infection first.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that *Actinomyces* infections are more commonly associated with long-term IUD use (often greater than 2 years). Clinicians should have a low threshold for suspecting this condition in patients with IUDs who present with symptoms of pelvic infection or abnormal cytology results.
## **Correct Answer:** . Remove IUD.