ALO (Actinomyces-like organism) is sometimes reported in smear test results. The cervical smear is not a reliable test for diagnosing infection as the test may detect bacteria that is harmlessly living on the lining of the vagina not causing infection.

• ALO have been identified in women both with and without intrauterine contraception.
• There is no need to change an intrauterine device in women with ALO if they are not experiencing any symptoms of infection.
• There is no benefit from removing and replacing the device following an ALO positive result and ALO may still be detected on future smears. The fitting procedure itself is associated with a small increased risk of pelvic infection.
• Infection caused by this family of bacteria (actinomycosis) is very rare.

Symptoms of true infection are abnormal discharge, lower abdominal pain, pain during sex or bleeding with sex. Signs of more severe infection include fever, feeling generally unwell, nausea or vomiting. If these symptoms are experienced it is very important to seek medical attention as soon as possible. Swabs are needed to detect ALO infection and also to test for other more common causes of these symptoms such as sexually transmitted infections (chlamydia, gonorrhoea).

Where infection is suspected antibiotic treatment will be recommended and started as soon as possible. The treatment will depend on the severity of the symptoms and will usually be started before swab results are available to avoid delay in treatment. If symptoms do not improve after three days of treatment removal of intrauterine contraception may be considered.

• Please contact your doctor or sexual health advisor for more confidential information.