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The IUCD‐assodated Incidence of Actinomyces israelii in the Female Genital Tract
Author(s) -
Cleghorn A. G.,
Wilkinson R. G.
Publication year - 1989
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1989.tb01787.x
Subject(s) - actinomyces israelii , pelvic inflammatory disease , medicine , incidence (geometry) , asymptomatic , sex organ , gynecology , obstetrics , actinomyces , pathology , biology , genetics , physics , bacteria , optics
EDITORIAL COMMENT: The gynaecological literature has in recent years carried a number of reports of pelvic inflammatory disease due to Actinomyces israelii, some with pelvic abscesses where surprisingly the infection was unilateral. This careful, large study provides readers with the incidence of colonization and clinical infection with Actinomyces israelii in women wearing IUCD's. This paper does not comment upon how often IUCD's should be changed but the data support the view that 4 years is long enough for any type of device. Readers should remember that there are other more common causes of pelvic infection (Chlamydia trachomatis and Neisseria gonorrhoeae) that can be activated by insertion of an IUCD. Acute or chronic pelvic inflammatory disease, with resultant tubal damage and consequent infertility, can also result from organisms of the Mycoplasma group, or an enteric pathogen, either aerobic (especially Escherichia coli) or anaerobic, especially one of the Bacteroides group. Because these organisms all respond to a course of tetracycline and metronidazole, these drugs are often prescribed empirically when an IUCD is inserted, especially if the patient is known to be promiscuous. The association between IUCD's and pelvic inflammatory disease seems a very good reason to advocate another method of contraception, especially in nulliparas. Summary: Cervical swabs and in many cases also intrauterine contraceptive devices were examined from 973 women for the presence of Actinomyces israelii . It was detected in 11.6% of these women, the majority of whom were asymptomatic. The detection, however, of A. israelii in the female genital tract was associated with an almost 4‐fold increase in the incidence of pelvic inflammatory disease (PID), indicating that colonization may progress to an infection in a small number of women. The incidence of A. israelii in the female genital tract of IUCD wearers was more than doubled when the IUCD was worn for longer than 4 years. The type of IUCD worn did not appear to be an important risk factor. Immunofluorescent staining of cervical smears identified 64% of cases. Specific culturing for A. israelii or cytological screening of Papanicolaou smears in addition were required to increase the isolation rate to nearly 90%.