ABSTRACT
Cervical Papanicolaou smears from 69,925 women were screened prospectively for the presence of Actinomyces israelii. The organism was not identified in non-intrauterine (contraceptive) device (IUD)-wearers. The prevalence of A israelii among IUD wearers ranged from 1.6% (general population) to 5.3% (clinic population). Protracted IUD use seemed to predispose to a higher incidence of infection. Direct immunofluorescence proved to be a more accurate and specific method of identification when compared with conventional light microscopy and anaerobic culture. Two of 112 women with direct immunofluorescence-proved A israelii had significant clinical infections. It appears that in the vast majority of cases, IUD-associated Actinomyces colonization produces only a superficial infestation. Conservative management is suggested for asymptomatic patients with cytologically detected Actinomyces to include removal of the IUD and repeated Papanicolaou smear after the next menstrual period.
PIP: Cervical Papanicolaou smears from a population of 69,700 women including 6450 IUD users were prospectively analyzed for the presence of Actinomyces israelii during a 20-month period. No clinical evidence of actinomycete-like organisms was found in any non-IUD wearers. In IUD users, 212 Papanicolaou stained smears or 1.6% were found positive with actinomycetes when examined by light microscopy. The length of time of IUD insertion averaged 6.1 years, with a range from 6 months to 14 years. A 2nd study of 225 family planning clinic patients revealed a 5.3% prevalence of Actinomyces israelii among IUD users. Average length of IUD use was 6.5 years, with a range of 1-14 years. Direct immunofluorescence appeared more accurate for diagnosis than light microscopy or Pap smears. The study suggests that protracted IUD use predisposes to a higher incidence of infection. No specific type of IUD was associated with higher risk. Only 2 patients had clinically significant infection and most were asymptomatic, suggesting that the organism causes a superficial infestation of the endometrium which is shed with the menstrual period. Full diagnostic workup with appropriate therapy is required for the management of clinically proven infection, while asymptomatic women with cytological evidence of Actinomyces may require conservative management, including IUD removal and repeated Pap smears.
