How do you manage recurrent bacterial vaginosis – or actinomycoses on a smear – in women with an IUD?
Bacterial vaginosis arises when the vaginal pH is raised above its usual acid levels. Women using IUDs or the IUS may have more bleeding days, which creates a more alkaline environment. But not all women with increased bleeding complain of symptoms of bacterial vaginosis. Condoms will prevent alkaline semen entering the vagina, and avoiding perfumed soaps and shower gels and douching may also prevent pH changes. Stopping smoking may prevent recurrence, as might metronidazole or clindamycin cream after an episode of bleeding. Actinomyces-like organisms (ALOs) are found as a vaginal commensal in women regardless of IUD use. The report of ALOs on a smear does not indicate infection with actinomyces but you should ask about symptoms – discharge, dysuria, dyspareunia, abdominal pain – which may require treatment. If symptomatic, swabs should also be taken for other STIs. If there are no symptoms, the IUD may be left in place and the smear only needs repeating at the routine screening interv
