Actinomyces in IUD users: management, prevention sparks controversy
Contraceptive Technology Update 2(3): 29-32
1981
ISSN/ISBN: 0274-726X PMID: 12337539 Document Number: 385476
A.H. Robins, makers of the Dalkon Shield, recently issued a letter to doctors suggesting that the problems of Actinomyces infection and colonization associated with long-term use of IUDs can be minimized by replacing inert IUDs at periodic intervals, generally not exceeding three years. However, David Eschenbach of the University of Washington believes that there are no final answers yet as to the prevention and management of this serious though rare disease, and recommendations are really just opinions. Actinomyces israelli is the species most commonly associated with pelvic colonization or infection; it is commonly a commensal organism of the oropharynx and the bowel, but not the genital tract. Symptoms that warn of infection of the genital tract include abdominal pain; nocturnal chills or sweats; vaginal discharge; intermenstrual bleeding; and increased menstrual bleeding. Infection can be fairly mild and resolved with IUD removal, or it can produce tubal abcesses, generally unilateral, which can be fatal, as in a young woman who developed massive pelvic abscess which later spilled 1500 cc of free pus into the abdominal cavity. Plastic inert IUDs are associated with a greater prevalence of Actinomyces infection than are copper-bearing IUDs. Pap smear can detect the presence of Actinomyces organisms, which are seen as branching filaments, sulfa granules or irregular islands of amorphous material which stain blue to brown or black. The organism may either be pathogenic or commensal, depending on the presence of leukocytes. Overall prevalence of Actinomyces showing up on Pap smears of IUD users is estimated at 80% to 90% of IUD users. Treatment suggestions depend on whether the patient has symptoms or is asymptomatic, and whether the presence of the organism represents an infection or a colonization. IUD removal, antibiotic treatment, and if necessary, surgical excision are recommended. Monitoring programs for IUD users are briefly discussed.