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  • Title: Actinomycins and intrauterine contraceptive devices: the clinicopathologic study.
    Author: Schmidt WA, Bedrossian CW, Ali V, Webb JA, Bastian FO.
    Journal: Diagn Gynecol Obstet; 1980; 2(3):165-77. PubMed ID: 7439012.
    Abstract:
    Since their widespread introduction in the early 1960s, IUD have been considered effective and safe. Early studies revealed the ability of the cavum uteri to regain bacteriologic sterility within 4 weeks of insertion. However, experience with long-term use indicates an enhanced risk of pelvic inflammatory disease, often of proven bacterial origin. Of these pelvic infections the most pernicious are those caused by Actinomyces. We present nine cases of actinomycotic female genital tract infection encountered in the past 3 years. The features of a distinct clinicopathology entity of IUD-associated actinomycotic pelvic disease are described. This disease is one of subtle protean manifestations and is not often diagnosed preoperatively. The most significantly pathogenic factors appear to be the duration of IUD use and the demonstrated relationship between IUD usage and infestation of the vagina with Actinomyces organisms. Although the IUD is considered a safe and effective form of contraception, long-term use increases risk of pelvic inflammatory disease (PID), often of proven bacterial origin. Of IUD-related pelvic infection, the most destructive are those caused by the genus Actinomyces. 9 cases of pelvic actinomycosis in IUD wearers are described by the authors. Actinomyces organisms were found in tissues from all 9--in cervicovaginal smears, material adherent to the IUD, the endometrium or tuboovarian abscesses. The clinicopathological features of the IUD-associated actinomycotic pelvic disease are described. The cases were compared with other cases in the literature which are clearly identifiable in terms of symptoms, diseased tissue and histologically or bacteriologically proven actinomyces organism. Duration of IUD use and demonstrated relationship between IUD usage and infestation of vagina with Actinomyces organisms appear to be the most important pathogenic factors. Early diagnosis and appropriate antibiotic therapy are important in the management of IUD-associated PID. IUDs should also be changed at least every 3 years and the removed IUD should be examined by a pathologist.
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