Diagnosis: Actinomyces Infection
• IUDs are not without complications. These complications include heavier menses, increased vaginal Candida infections, and increased incidence of pelvic inflammatory disease (PID) in the setting of multiple sexual partners.
• Progestagen-containing IUDs result in endometrial change associated with progestin administration known as pseudodecidualization of the stroma. Chronic endometritis containing plasma cells is also associated with IUD use.
• Uterine actinomycosis is usually superficial, but deep infection has been reported. In rare cases, the infection may become systemic and may be fatal. Establishment of the correct diagnosis followed by IUD removal and proper antibiotic therapy is recommended when Actinomyces is detected in a Pap smear or in endometrial curettings.
• The length of time the IUD remains in the uterus increases the risk for Actinomyces infection. Most cases of Actinomyces are recognized in women who have had IUDs for periods longer than 1 year. Rarely, Actinomyces is seen on the Pap smears of women who do not have IUDs, making recognition of the organism important even without accompanying clinical history.
• Forgotten tampons and pessaries are also culprits in Actinomyces infection. Ascending infection is thought to derive from the perineum or from orogenital and anogenital contact.
• Actinomyces is commonly recognized because of the characteristic presence of sulfur granules.
