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. STUDY DESIGN: 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). CONCLUSION: 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.