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  • Title: Short-term failure of IUD removal to alter bacterial flora in a patient with chronic anaerobic endometritis.
    Author: Monif GR.
    Journal: Am J Reprod Immunol Microbiol; 1986 Oct; 12(2):55-7. PubMed ID: 3789249.
    Abstract:
    A patient with cytological and clinical evidence of IUD-associated anaerobic endometritis was studied with quantitative and qualitative bacteriological techniques. With the exception of elimination of Actinomyces israelii from the deep endocervical/endometrial culture, IUD removal induced minimal qualitative changes in the bacterial flora of the endocervical/endometrial sample during the 35 days the patient was monitored. The interposition of menstruation did not significantly alter either the quantitative or qualitative interrelationship of the bacteria present. A case study is reported of a 34-year-old para 4-0-1-4 with cytological and clinical evidence of IUD-associated anerobic endometritis. The purpose of this report is to use quantitative and qualitative microbiology in conjunction with sophisticated anerobiology in analyzing the impact of IUD removal on the deep endocervical flora of a patient with IUD-related chronic polymicrobial anerobic endometritis (CAE). Approximately 6 years and 7 months before the examination, the patient had a Dalkon Shield inserted following the birth of her 4th child. About 6 months prior to referral to the Shands Teaching Hospital, the patient began experiencing menstrual irregularities. A routine Papanicolaou smear performed 5 months later revealed pseudomycelial clumps of bacteria that stained positive with a silver stain amidst an intense inflammatory background. On the basis of the cytological findings and the history of menstrual irregularities, the diagnosis of CAE was made and the patient was referred for evaluation and IUD removal. In retrospect, it was learned that the patient had been having a malodorous intermenstrual discharge for an unspecified period of time. The patient was microbiologically sampled on the 20th day of the ensuing cycle and 1 week later. Because of persistence of the anerobic endocervical flora, a single 2-g dose of metronidazole was administered. The patient was re-examined at 9 days and 7 weeks post therapy. Table 1 lists the qualitative bacteriological data, aerobic and anerobic, of the pre- and postremoval cultures. Papanicolaou smears made directly from the IUD demonstrated the presence of Gram-positive filamentous bacteria morphologically consistent with "Actinomyces israelii." With the exception of an interchange among the Enterobacteriaceae, a quantitative reduction of the alpha streptococci and the elimination of the Gram-negative nonfermenting bacilli, there were no significant changes in the aerobic flora prior to IUD removal and 28 days later. Besides the post-IUD removal culture and premetronidazole culture 7 days later, the alpha streptococci were further reduced below threshold quantities following metronidazole administration. Following IUD removal, the "Propionibacterium" species and "Actinomyces israelii" were eliminated. The 6 other anerobic bacteria -- "Peptococcus" species, "Peptostreptococcus" species, Gram-positive nonsporeforming bacilli, "Bacteroides fragilis," "Bacteriodes melaninogenicus," and "Fuscobacterium" species -- persisted. No significant quantitative changes occurred. The only change in the post-IUD removal and premetronidazole culture was greater than 3 log increase in the peptococci present. Following the administration of metronidazole, the anerobic flora was eradicated.
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