Detection and Prevalence of IUD-Associated Actinomyces Colonization and Related Morbidity

Abstract

Cervical Papanicolaou smears from 69,925 women were screened prospectively for the presence of Actinomyces israelii. The organism was not identified in non-intrauterine (contraceptive) device (IUD)-wearers. The prevalence of A israelii among IUD wearers ranged from 1.6% (general population) to 5.3% (clinic population). Protracted IUD use seemed to predispose to a higher incidence of infection. Direct immunofluorescence proved to be a more accurate and specific method of identification when compared with conventional light microscopy and anaerobic culture. Two of 112 women with direct immunofluorescence-proved A israelii had significant clinical infections. It appears that in the vast majority of cases, IUD-associated Actinomyces colonization produces only a superficial infestation. Conservative management is suggested for asymptomatic patients with cytologically detected Actinomyces to include removal of the IUD and repeated Papanicolaou smear after the next menstrual period.

Ureteral and Sigmoid Obstruction Caused by Pelvic Actinomycosis in an Intrauterine Contraceptive Device User

“…Gupta et al [9] have elucidated the occurrence of Actinomyces in cervico-vaginal smears of IUCD users. Colonization occurs much more frequently than infection [10] and the rate of infection increases with the length of time the IUCD has been in place [3,11,12]. In most cases, unilateral or bilateral tubo-ovarian abscesses are present [3].…”

“…Actinomycosis must first be suspected in any woman with a history of current or recent IUCD use who presents with abdominal pain or pelvic mass. A definitive diagnosis cannot be made on clinical grounds alone, but the organism can be detected on histological samples from the removed IUCD, in Papanicolaou-stained smears and anaerobic cultures, and most sensitively, by immunofluorescence [11]. If recognized preoperatively, a limited surgical procedure, if indicated, can spare the patient from extensive surgery, limiting the overall morbidity of the disease and the potential mortality due to the surgery.…”

Study of Microbial Flora of Female Genital Tract in Intrauterine Contraceptive Device Users

“…This correlates with the study by Elhag et al, (5) in which Actinomyces was only isolated from IUCD users. Valicenti et al, (13) study has stated that IUCD has been shown to induce a mild inflammatory response in the endometrium, with focal necrosis which creates an environment favourable for Actinomyces and other anaerobic organisms. Lactobacilli were isolated at a lesser frequency from women with IUCD in situ when compared to women prior to insertion.…”

In vitroactinomycete biofilm development and inhibition by the polyene antibiotic, nystatin, on IUD copper surfaces

“…Furthermore, Actinomyces species in the endometrial cavity have been found to be associated with long periods of IUD use and are commonly associated with chronic endometritis (Valicenti et al 1982). With this viewpoint, in the present study the authors sought to isolate actinomycete strains from the endocervical swabs of IUD users.…”