Pelvic actinomycosis associated with intrauterine contraceptive devices.

In the last 10 years several cases of pelvic actinomycosis have been reported in women using an IUD. 1 such case of a 35-year-old white woman gravida 2 para 2 is reported. The woman had been using a Dalkon Shield for over 7 years. Exploratory laparotomy revealed bilateral tubo-ovarian abscesses and bilateral therapeutic salpingo-oophorectomy was performed. Although the abscess wall revealed "sulfur granules" characteristic of actinomycosis infection the cultures were negative. The presumptive diagnosis remains actinomycosis based on the finding of sulfur granules. It is felt that IUDs predispose to actinomycosis colonization by causing chronic trauma to the endometrium resulting in a mass of necrotic tissue which serves as a culture medium for the organism. The problem has been noted with both metallic and plastic IUDs. Most of the severe cases have occurred in women using an IUD for more than 3 years. It is not known whether the actinomycosis is the major pathogen or whether it causes changes in the pelvic tissue predisposing to additional organisms. Symptoms of actinomycosis are: pelvic pain purulent discharge bleeding and fever. Signs include pelvic tenderness and a pelvic mass. There can however be severe infection with only minimal symptoms. Treatment includes both surgery to drain the abscess and antibiotic therapy.