[Utero-ovarian actinomycosis and intrauterine contraceptive devices].

Abdominal actinomycosis was previously rare and difficult to diagnose but utero-ovarian infection in IUD users is becoming more frequent. The case of a 47-year-old IUD user admitted to a French hospital for suspicion of salpingitis or diverticular sigmoiditis is described. An inflammatory tumor of the left ovary and tube seemed to have invaded adjacent organs and a hysterectomy including the adnexa was performed with great difficulty. Numerous actinomycosic grains were found in the uterine cavity in contact with the IUD as well as in the left ovary and tube. The etiology of infection with Actinomyces israeli is not well understood. A. israeli is an anerobic bacteria habitually found in human body cavities. It appears incapable of crossing a healthy mucus; development of disease requires a lesion of some kind. The presence of some other germ especially anerobic bacteria also seems to be required. The infection diffuses by contiguity or in the blood seldom in the lymph system. A series of studies that found A. israeli in the cervical smears of a proportion of IUD users but never or seldom in nonusers and examinations of IUDs removed after varying periods of use demonstrate that the presence of the IUD is the determining factor in the appearance of utero-ovarian actinomycosis. The condition is often asymptomatic and there is a long latency period. Researchers have related both the presence of the bacteria and the appearance of clinical manifestations to the duration of use of the IUD. It is not clear whether a particular type of IUD is more likely to be involved. It has been suggested that calcium deposits on IUDs form niches where the infections develop. In over 1/2 of cases a pathologist rather than a bacteriologist made the diagnosis often after ruling out malignancy. The infection tends to produce more or less chronic inflammatory lesions characterized by induration of tissues which give a pseudoneoplastic aspect and are sometimes responsible for more or less radical excisions before the true diagnosis is made. The lesions all have the actinomycosic grains the element that leads to diagnosis. The appearance in an IUD user of leukorrhea menometrorrhagia pelvic pain and fever should arouse suspicion of utero-ovarian actinomycosis especially if the condition is subacute or chronic. The IUD should be removed and bacteriologic studies done. Early diagnosis depends on observation of the bacteria on cervical smears or removed IUDs. A. israeli is sensitive to numerous antibiotics the treatment of choice but the duration of treatment remains controversial. With correct diagnosis and antibiotic treatment much surgical intervention can be prevented. It appears that all IUDs should be changed every 2 years and cytobacteriologic examinations done every 6 months for women using IUDs.