The presence of intrauterine contraceptive devices (IUDs) provides a solid surface for attachment of microorganisms and an ideal niche for the biofilm to form and flourish. Vaginal candidiasis is often associated with the use of IUDs. Treatment of vaginal candidiasis that develops in connection with IUD use requires their immediate removal. Here, we present in vitro evidence to support the use of combination therapy to inhibit Candida biofilm. Twenty-three clinical Candida isolates (10 C. krusei and 13 C. tropicalis) recovered from endocervical swabs obtained from IUD and non-IUD users were assessed for biofilm-formation ability. The rate of isolation of Candida did not differ significantly among IUD and non-IUD users (P = 0.183), but the biofilm-formation ability of isolates differed significantly (P = 0.02). An in vitro biofilm model with the obtained isolates was subjected to treatment with amphotericin B, tyrosol, and a combination of amphotericin B and tyrosol. Inhibition of biofilm by amphotericin B or tyrosol was found to be concentration dependent, with 50% reduction (P < 0.05) at 4 mg/l and 80 μM, respectively. Hence, a combination effect of tyrosol and amphotericin B was studied. Interestingly, approximately 90% reduction in biofilm was observed with use of 80 μM tyrosol combined with 4 mg/l amphotericin B (P < 0.001). This represents a first step in establishing an appropriate antibiofilm therapy when yeasts are present.

Pelvic actinomycosis constitutes one of the curiosities of gynecology. In this present investigation the presence of actinomycetes infection among Intrauterine device (IUD) users and its correlation correlated with the development of Pelvic Inflammatory Disease (PID) and ovarian carcinoma was studied. Endocervical swabs were obtained from ovarian carcinoma, IUD users, non-users and processed to isolate actinomycetes on actinomycetes isolation agar. The isolation rate was found to be increased among IUD users who were clinically diagnosed to have PID (52.9%) followed by ovarian carcinoma cases who were prior users of IUD (44.4%). Compared to healthy non-IUD users, IUD users with PID experienced a 158 fold statistically significant increased risk of actinomycetes infection (OR = 158.63, 95% CI = 17.84, 161.11) followed by ovarian carcinoma patients with IUDs (OR = 112.80, 95% CI = 10.59, 120.02). The isolates showed high resistance against penicillin, clindamycin and erythromycin and low resistance against tetracycline, linezolid and gentamycin. The use of IUDs facilitates the colonization by actinomycetes which in turn lead to PID and pelvic actinomycosis. Further the pelvic actinomycosis simulates pelvic malignancies. If chronic actinomycetes infection are encountered, the patients should be given long term therapy with aminoglycoside antibiotics and if a pelvic mass is evident aggressive and prolonged antibiotic therapy with surgical intervention is required.