Pelvic actinomycosis

• Actinomyces are part of the normal vaginal flora - however Actinomyces is rarely detected in the absence of intrauterine contraceptive devices (IUCDs) (1)
• if actinomyces-like organisms (ALOs) and intrauterine contraceptive (IUC) device
  • If ALOs are identified and the woman presents with symptoms of pelvic pain, then removal of IUC may be considered. Treatment involves high-does antibiotics for at least 8 weeks and health professionals should consult with a microbiologist. Other more common causes of pain (including STIs) should be excluded
    • has been suggested that asymptomatic women with positive ALOs on a cervical smear are more likely to be colonised by ALOs than infected, with the IUD potentially providing a good surface for the development of biofilm in vivo
      
      
    • there is no need to remove IUC in asymptomatic women with ALOs
      
      
    • for women who require a replacement device but have ALOs identified there is some evidence to suggest that immediate reinsertion or a short delay of 3-5 days is safe
      
      
    • insertion or reinsertion of an intrauterine method can be carried out in asymptomatic women with ALOs (3)
      
      
    • there is no need to remove IUC in asymptomatic women with ALOs (3)
      • if asymptomatic then (5):
        • coil does not need to be removed and antibiotics are not required
        • patient should have an abdominal and pelvic examination
        • patient should be warned of the small possibility of developing pelvic actinomycosis and advised to return should she develop symptoms
        • family planning follow-up should be arranged every six months and should include enquiry regarding new symptoms and a pelvic examination
        • repeat cytology is not required unless the smear was graded inadequate/abnormal i
        • f the asymptomatic patient wishes the device to be removed or it is due for removal then it need not be sent for culture.

Notes:

• actinomyces israelii is a commensal of the female genital tract.
  • Actinomyces-like organisms (ALOs) have been identified in women with and without IUC - although it is acknowledged that the level is thought to be low and that actinomycosis is rare
  • role of ALOs in infection in women using IUC is unclear

Reference:

• (1) Medical Microbiologist (Winter 1997), 5.
• (2) Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ. 2011;343:d6099
• (3) FSRH Guidance (April 2015) Intrauterine Contraception
• (4) CKS. Contraception - IUS/IUD (Accessed 23/7/19)
• (5) Mid-Cheshire Hospitals NHS Foundation Trust. Actinomyces-like organisms on a cervical smear (Accessed 23/7/19).