Recent reports suggest a relationship between intrauterine contraceptive device (IUD) use and colonization or infection of the genital tract with Actinomyces species. This prospective, case-controlled study was designed to determine the incidence of colonization or infection with Actinomyces in IUD users. None of 50 control patients and four of 50 study patients (8%) had Actinomyces identified. None of the patients with positive results had symptomatic pelvic infection. Cervical cytology was effective in detecting each of the four study patients with positive results. It appears that the presence of any type of IUD is a major predisposing factor to colonization with Actinomyces.
PIP: Recent reports indicate that colonization or infection of the genital tract with Actinomyces israelli (an anaerobic, gram-positive, non-acid fast, obligate parasite classified between the true bacteria and complete fungi) may be related to IUD use. To determine the incidence of Actinomyces infection in IUD users and a comparable samples of nonusers, a prospective controlled study was undertaken using 50 study and 50 control patients from the Grady Memorial Hospital's gynecology and family planning clinics. The age and parity of the 2 groups ranged from 17 to 52 years, and 1.9 to 2.8, respectively. Selected risk factors predisposing to colonization or infection with Actinomyces were considered and included frequency of intercourse per week; contraceptives used; and histories of appendicitis and pelvic inflammatory disease (PID). Both groups were divided into women less than 35 years of age and those more than 35 years of age. There were 29 control and 9 study patients in the older group. Of the 9 study patients, 4 (44.4%) had Actinomyces compared to none of the 29 control patients (p .01). The Lippes loop, which was used by 50% of the IUD users, was the most commonly removed IUD. The characteristics of the 4 patients were described in Table 5. Cervical cytology was used in detecting the Actinomyces infection or colonization of the 4 study patients, who were managed by IUD removal and follow-up biopsies or Pap smears. Symptomatic patients should have their IUDs removed and should be treated with antibiotics to provide both aerobic and anaerobic coverage.