Pelvic Actinomycosis and the Intrauterine Contraceptive Device: A Cyto-histomorphologic Study

Abstract

In 350 pancervico-vaginal (Fast) smears obtained from women using intrauterine contraceptive devices, organisms consistent with Actinomycetes have been found. Actinomycetes, representing cervicitis, endometritis, and pelvic abscesses clinically, have been observed histologically in some of these cases. Special stains, immunofluorescence, and anaerobic cultures have confirmed these organisms to be Actinomyces israelii. Actinomyces in the Fast smear occur in isolated clumps, revealing branching, filamentous organisms, and sulfur granules. They can be detected and diagnosed in a Papanicolaou-stained routine pancervico-vaginal smear. This diagnosis in Fast smears can identify users of intrauterine contraceptive devices who may have Actinomyces infection in the genital tract and who are at risk of developing clinical disease related to this infection.

Clinical Features of Abdominopelvic Actinomycosis: Report of Twenty Cases and Literature Review

“…The most likely route of spread with subsequent development of pelvic abscess appears to be through patent fallopian tubes. The use of IUD may increase the risk of infection through injury to the normal uterine mucosa 13,23. Pelvic actinomycosis associated with the use of IUDs can mimick pelvic malignancy 24.…”

Intrauterine Contraceptive Device-Related Actinomycosis Infection Presenting as Ovarian Cancer with Carcinomatosis

“…Abdominal actinomycosis usually occurs following a bowel perforation, especially perforated appendicitis, or following endometriosis from the use of an IUD. Pelvic actinomycosis has become more prevalent and is associated almost exclusively with use of an IUD, which may increase the risk of infection through injury to endometrium [5]. Actinomycosis israelii infects 1.65%-11.5% of IUD users, and infection is more common in women who have had an IUD in longer than four years.…”

Preoperative diagnosis of pelvic actinomycosis by clinical cytology

“…We could detect sulfur granules on postoperative histopathology in four of our eight patients (50%, Figure 3A). However, abundant sulfur granules are rarely visible on cytology without close examination of large numbers of samples 20,21…”