An Ob/Gyn colleague calls you regarding a patient of theirs, who is a 45 year old female with a history of Hepatitis C and prior injection drug use who came in for a routine PAP smear. She has an intrauterine device (IUD) in place for contraception, and uses female condoms irregularly for STI prevention. When performing her PAP, they noticed an irregularity on her IUD and removed it. They saw multiple ‘teeth-like’ structures on the IUD, without any purulence or sulfur granules. There were 10-15 of them on the device. She has been afebrile and asymptomatic this entire time, and is surprised and concerned about the findings on the IUD. The Ob/Gyn surgeons ask you for your advice.

What do you tell them?

1. This is an Actinomyces infection, removing the IUD alone is usually sufficient
2. This is Gonorrhea, give the patient intramuscular ceftriaxone along with oral doxycycline, and remove the IUD
3. This is HSV, start valacyclovor by mouth; no need to remove the IUD
4. This is a teratoma, call Oncology to help evaluate further
5. This is an extra-hepatic manifestation of her Hepatitis C, start antiviral therapy and remove the IUD

Answer later this week!