Intrauterine Contraceptive Device-associated Actinomycotic Abscess and Actinomyces Detection on Cervical Smear

Objective: To summarize clinical features and treatments in reported cases of actinomycotic pelvic abscess occurring in women using intrauterine contraceptive devices (IUD), and to review detection of Actinomyces by cervical smear.

Data Sources: The English-language medical literature accessed through MEDLINE.

Methods Of Study Selection: We identified 92 cases of actinomycotic abscesses associated with IUD use in 63 case reports. In addition, 31 studies of Actinomyces detection were found, 16 of which were studies of Papanicolaou smear-based detection. DATA ABSTRACTION AND SYNTHESIS: Data regarding clinical presentation and treatment were culled from case reports, whereas detection rates of Papanicolaou smear and other methods were obtained from studies of Actinomyces detection. The average patient was 37 years old, had been using an IUD for 8 years, and presented with abdominal pain, weight loss, vaginal discharge, and fever. Laboratory studies commonly revealed anemia, leukocytosis, and an elevated erythrocyte sedimentation rate. Most of these patients underwent operative procedures, usually hysterectomy and salpingoophorectomy. High-dose penicillin was found to be an effective antibiotic. Detection rates of organisms on Papanicolaou smear were somewhat variable; use of other detection methods, including endometrial biopsy, culture, and immunofluorescence, did not improve this variability.

Conclusions: Pelvic actinomycosis associated with the use of IUDs can mimic pelvic malignancy; for that reason, it is often treated surgically. However, if the diagnosis of actinomycosis can be obtained preoperatively, antibiotic treatment may lead to complete resolution. The Papanicolaou smear may be useful in evaluating such patients.