pelvic actinomycosis

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  • 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:

Last edited 07/2019

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