A woman who wears an intrauterine device (IUD) for contraception may be at increased risk for developing genital or pelvic actinomycosis. The infection usually develops within the endometrial cavity. If one or both fallopian tubes is patent, then the infection can spread to the pelvis.
Risk factors:
(1) prolonged use of the IUD (>= 24 months)
(2) type of IUD
Clinical findings:
(1) current or past history of an IUD (may be years past)
(2) fever
(3) vaginal discharge
(4) abdominal and/or pelvic pain
(5) weight loss
Laboratory findings:
(1) leukocytosis
(2) elevated ESR or CRP
(3) sulfur granules in a Papanicolaou (Pap) smear
Complications:
(1) adnexal or pelvic mass that may be mistaken for a tumor
(2) bowel or urinary tract obstruction
Management:
(1) Removal of the IUD is important for controlling the infection and preventing future recurrences.
(2) Antibiotic therapy for up to 6 weeks..
(3) Drainage of any abscess may be necessary.
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