Actinomycosis of the cervix uteri during the use of IUD

The gram-positive bacteria Actinomyces israeli are widely distributed in nature and exceptionally hardy. As long as the bacteria dont penetrate the surface of mucosal membranes they are non-pathogenic. Actinomycosis is a rare genital infection. Only about 200 cases have been described. One such case is described here because the probable route of infection was an abrasion received during insertion of an IUD. A 40-year-old woman had an IUD inserted on 7/22/76. When she was seen for an annual examination a year later she reported no problems and no abnormalities were found. A half year later she visited the gynecological clinic with inflammatory symptoms. An enlarged uterus was found and a pregnancy test was negative. Therapy with antibiotic suppositories was begun. A return visit after a menstrual period indicated further enlargement of the uterus. A hysterectomy which revealed fibroid tumors abscesses and some precancerous changes around the abscessed areas was performed. Because of the suspicion of cancer a bilateral ovaiectomy was also carried out. Post-operative care included a 12-day hospital stay and antibiotic therapy. The pathology report was as follows: 1) cervix - chronic inflammatory cervicitis and abscesses of actinomycotic etiology were found; 2) uterus - indicated chronic endometritis; 3) leiomyoma - showed mildly elevated proliferative activity; 4) ovaries - were normal; and 5) urine - was normal. A chest X-ray and nose throat and rectal cultures were carried out to ensure that infection was not present in other body systems but these tests were negative. To complete the therapy the patient was given 1.5 million units of penicillin daily for 3 months. She recovered completely.