Actinomyces species associated with intrauterine contraceptive devices and pelvic inflammatory disease
Tendolkar, U.; Pandit, D.; Khatri, M.; Deodhar, L.
Indian Journal of Pathology and Microbiology 36(3): 238-244
1993
ISSN/ISBN: 0377-4929 PMID: 8300169 Document Number: 333830
Actinomycetes have been recognized in association with IUDs and pelvic inflammatory disease (PID) although the exact origin and routes by which the actinomyces arrive in the vagina are unknown. It is clear, however, that once in the vagina, bacteria may be pulled into the uterus by the tails of IUDs like the Dalkon Shield. The authors report findings from the collection and study of endocervical swabs after decontamination of vagina and with IUDs in situ from 112 women attending for IUD removal. The mucus debris adherent to the removed IUD was also swabbed for microbiological study along with endocervical swabs from 65 clinically diagnosed cases of PID. The presence of Actinomyces was sought using direct fluorescent antibody test and culture. Actinomyces species isolated included Actinomyces israelii, Actinomyces naeslundii, and Actinomyces viscosus, and were identified in 20.5% of IUD wearers and 12.3% of patients with PID. A 71.4% isolation rate resulted using the selective medium Actino Blood Agar. No actinomyces were detected in the 50 control subjects. Studies suggest that the presence of any type of IUD, regardless of the duration of use, predisposes a patient to colonization or infection with Actinomyces. Symptoms of vaginal discharge, pain, and menstrual disturbance in association with Actinomyces have also been noted in other studies. The authors, in closing, stress the need to isolate and properly identify the Actinomyces species, with the presence of Actinomyces in IUD wearers warranting removal of the device.
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