| Abstract: | The continuing presence of an IUD, which is a foreign body, is frequently associated with increasing colonization of the cervix with aerobic and anaerobic organisms, among which growth or actinomycetes have been identified. Actinomyces israelii is the principal pathogen of the actinomycete family or organisms. A delicate slow growing anaerobe of low pathogenicity, it has been cultured from the gut and recently has been identified in vaginal smears of women without an IUD. Yet, thus far, microscopically recognizable growths in direct cervical smears and positive cultures have been obtained only in the presence of an IUD or other foreign body. 2 mechanisms have been described by which organisms from the vaginal pool and lower endocervical canal can spread throughout the genital tract. There is increasing evidence that the presence of the tail of the IUD helps the ascent of organisms from the vagina into the body of the uterus. Also, calcium encrustation and disintegration of the IUD, which at times occur after prolonged use, results in migration of fragments of calcium encrusted plastic throughout the genital tract. These form niduses for colonization of actinomycetes and other organisms. In the presence of an IUD, actinomycetes have been reported with increasing frequency in routine cervical smears of women who have been almost or totally symptom free. Histologically and bacteriologically verified cases of pelvic actinomycosis are rare. Prior to the introduction of the plastic IUD, documented cases were mainly associated with large bowel disease. Now an increasing number of cases (to date over 100) have been recorded in association with IUD use. Clinically, pelvic actinomycosis usually presents as a low grade smoldering infection. The initial symptoms are mild: often general ill health and slight fever, with chills and sweats. Offensive discharge, pelvic tenderness, or a mass may develop late, and occasionally the patient is hospitalized with a ruptured pelvic abscess. Culture identification is a problem unless measures are taken to inhibit the growth of more robust and fast growing anaerobes by metronidazole and a dilution technique. When actinomyces like organisms are found in cervical smears and the finding is confirmed by Gram stain or by culture and/or immunofluorescence, the patient should be informed in general terms. The IUD should always be removed, if necessary under antibiotic cover, and if the patient so desires, a new IUD may be inserted after the infection has cleared. |
