IUD-associated infections: diagnosis and treatment of pelvic actinomycosis.
Pelvic actinomycosis, an IUD-associated infection caused by Actinomyces israelii bacteria, often manifests as a pelvic abscess. In order to establish an infection, Actinomyces israelii requires a foreign body such as an IUD; it can migrate up the filamentous string and infect the site of cavitation created by the device. The most common presented symptoms in infected women are abdominal pain, abnormal vaginal discharge, fever, and weight loss. These women are usually diagnosed as having pelvic inflammatory disease with or without tubo-ovarian abscess through bacterial culture, endometrial biopsy, needle biopsy, or surgery. Treatment includes removal of IUD in women with Actinomyces organisms present in their Pap smear. A follow-up Pap smear in 6-8 weeks after removal of IUD is indicated among asymptomatic patients. A pelvic ultrasound, as well as a complete blood count and an erythrocyte sedimentation rate should then be performed if the organisms persist to rule out pelvic abscess. Penicillin, tetracycline, and doxycycline are the recommended drugs for patients with no abscess. Otherwise, ampicillin or penicillin, together with aminoglycoside, clindamycin, or metronidazole, is administered to those with pelvic abscess. Complications of pelvic actinomycosis include tubal damage resulting in tubal occlusion and infertility, ectopic pregnancy, and chronic pelvic pain.