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  • Title: Actinomycosis infection associated with intrauterine contraceptive devices.
    Author: Keebler C, Chatwani A, Schwartz R.
    Journal: Am J Obstet Gynecol; 1983 Mar 01; 145(5):596-9. PubMed ID: 6829637.
    Abstract:
    Papanicolaou-stained cervicovaginal smears from 478 women with intrauterine contraceptive devices (IUDs) in place were reviewed for the presence of Actinomyces colonies. The overall infection rate was 12.6%. Plastic IUDs had a significantly higher infection rate than that of Copper 7 IUDs. The infection rate was found to increase with the duration of use of IUDs. The presence or absence of Actinomyces was not related to age, race, parity, previous abortions, or financial status of the patients. 478 patients of the Temple University Hospital Family Planning Clinic who had Papanicolaou smears taken during intervals of IUD use where included in this study of the prevalence of actinomycetic infections in IUD users. The classification of the Pap smear and the presence or absence of Actinomyces in each smear were determined, and all positive slides were reviewed to confirm the presence of Gupta bodies. No Pap smears prior to IUD insertion showed evidence of Actinomyces, and once a smear showed evidence of Actinomyces, all subsequent ones were positive until the IUD was removed. Evidence of Actinomyces was found in 60 of the 478 patients, indicating a 12.6% infection rate. No correlation was found between presence of infection and race, financial status, number of previous abortions, or size of IUD. Patients with Class I smears had a 9.4% rate of infection and those with Class II smears had a 14.5% rate of infection. Nulliparous women had an 8.4% rate, compared to 13.9% for parous women. The differences in the rates of infection for these variables were not statistically significant. The Saf-T-Coil was used by approximately 77% of the patients, the Cu-7 by approximately 11%, the remainder using other plastic IUDs. Infection rates were 13.1% for the Saf-T-Coil, 13.6% for the other plastic devices, and only 2% for the Cu-7. There were no statistically significant differences in the mean age, parity, or number of abortions between the noninfected and infected group, but the mean duration of IUD use in infected patients was 30.6 months compared to 24.3 months for uninfected patients, a statistically significant difference. The Cu-7 had a significantly shorter duration of use than that of the other IUDs. Data were insufficient to determine whether the shorter duration of use of the Cu-7 was the cause of its lower infection rate. It is recommended that cytologic laboratories report Pap smears containing Gupta bodies to the clinician and that treatment be initiated.
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