Pelvic actinomycosis associated with the use of an intrauterine device (IUD) is a recently recognized combination. The usual manifestation of the disease are those of mild pelvic inflammatory disease (PID) in a woman who uses an IUD. The disease is easily recognized on Papanicolaou-stained cervicovaginal smears. Early treatment involves removal of the IUD and administration of penicillin. Rarely, the disease may be serious and may require drainage of intra-abdominal abscesses, hysterectomy with salpingo-oophorectomy, or both. The second known death from pelvic actinomycosis associated with use of an IUD is reported.
PIP: Recent reports suggest that pelvic inflammatory disease (PID) is more common among users of the IUD than among those using other forms of contraception and that there is an association between IUD use and pelvic actinomycosis. In 1979 a woman at the University of New Mexico Hospital died from pelvic actinomycosis, the 2nd reported death from this disease associated with the use of an IUD, although her death from pulmonary embolus and Candida endocartidis should more appropriately be considered a complication of intravenous hyperalimentation. At least 25 patients are reported to have had serious pelvic actinomycosis associated with the use of an IUD. No particular type of IUD seems less likely to be associated with actinomycosis. Actinomyces are normally present in the gut and oropharynx, so that inoculation of the vagina with stool or saliva in combination with trauma induced by the foreign body such as an IUD may allow the actinomyces to enter tissues. Actinomyces are easily detected by Papanicolaou-stained cervicovaginal smears and are present in as many as 25% of symptomatic women using IUDs. Culture techniques usually fail in detecting actinomyces, the need for an anaerobic environment or overgrowth by bacteria which invariably accompany actinomyces are the usual causes of failure. Usual signs of IUD-associated actinomycosis are pelvic and lower abdominal or back pain, vaginal discharge, fever, and elevation of leukocyte count which are similar to symptoms of mild PID. Therefore these symptoms demand a Papanicolaou-stained cervicovaginal smear and search for actinomyces. Treatment includes removal of the IUD and administration of penicillin. However at least 1 patient after receiving treatment returned later with actinomycotic tubo-ovarian and subphrenic abscesses. A period of at least 4-6 weeks of therapy is usually recommended. Most patients with pelvic masses underwent hysterectomy and bilateral salpingo-oophorectomy in addition to penicillin and IUD removal; a few were successfully treated with drainage of an intra-abdominal abscess.