Not much on actinomycosis and IUD's in recent literature. I found one article,
however, that recommends pulling the IUD. If the IUD is left in ploace and
there are problems, plaintiff's attorney would no doubt be aware of the
article.
--
IPPF Med Bull. 1983 Jun;17(3):1-2.
Actinomycosis and IUDs.
Duguid HL.
PIP: 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.
- - - -
Date: Fri, 10 Mar 2006 08:47:12 -0600
From: "S Osterling M.D." <sdoesterling-obgyndotnet@yahoo.com>
Subject: Re: Actinomyces
There was a recent (late 1990's) grey journal article about this. They argued
that it is part of floral and that it should not be removed.
I work for a big county health system and get this call once or twice a year.
We never pull them or treat for it.
On Mar 10, 2006, at 6:25 AM, art fougner, md wrote:
Having dealt with a patient with pelvic actinomycosis iud-related, i
would pull the iud ... not evidence-based, mind you, but once bitten,
twice shy.
art
At Fri, 10 Mar 2006, Rafael Haciski wrote:
I received a report of actinomyces on a recent PAP in an
asymptomatic, IUD wearing, late 20's aged patient (routine annual exam).
While my immediate reaction is to remove the IUD (copper T if I
recall correctly), am I over-reacting?
Should I leave it alone? While on one hand there is a negative
association with IUDs, Actinomyces is (although rarely reported on
routine PAPs or vaginal cultures) considered a member of normal
vaginal flora.
What does the collective wisdom say?
--
Rafael Haciski MD FACOG
Palmetto, FL
--
art fougner, md
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S. Osterling M.D.
California
