The effect of a copper intra-uterine contraceptive device on the microbial ecology of the female genital tract

Abstract

Bacteria isolated from 108 intra-uterine contraceptive devices (IUCD) removed from patients with pelvic inflammatory disease (PID), haemorrhage, pregnancy and from asymptomatic women, and from the genital tracts of 66 healthy controls not wearing an IUCD, were studied. No significant differences were found in the types of micro-organisms or isolation rates from IUCDs removed from women in the various clinical groups. The isolation rate of anaerobic bacteria from IUCDs removed from asymptomatic wearers was significantly lower than that from controls, with the exception of the isolation rate of actinomyces which was significantly higher in IUCD wearers and A. israelii was recovered only from IUCDs. The isolation rates of the different bacterial species varied with the duration of the device in utero. The presence of a copper IUCD altered the bacterial flora of the female genital tract. The insertion of such a device and the ecological changes that follow play a crucial role in the development of PID.

PIP: The bacterial flora of the cervix and vagina were examined in 108 patients who had copper IUDs removed and in 66 controls at the Maternity Hospital and Maternal Welfare Clinics in Kuwait. The IUDs removed were the Nova-T, Copper 7, and Cu 250. 15 of the women having IUDs removed had pelvic inflammatory disease; 21 had irregular bleeding; 11 had suprapubic pain, vaginal discharge, or uterine perforation; and 51 were asymptomatic. Actinomyces species, particularly Actinomyces israelii, and Arachnia propionica were isolated from 16 of the IUD wearers but only 2 of the controls. Lactobacillus species were isolated from 10 of the IUD wearers and 25 of the controls. Anaerobic cocci were isolated from 13 device wearers and 12 controls. Except for Actinomyces, anaerobic bacteria were isolated from controls more often than from the IUD wearers. Copper is known to have an antibacterial effect on gram-positive anaerobes, and even Actinomyces was absent from IUD wearers who had worn the device less than a year, i.e., during the period of maximum copper release. Moreover, no significant difference was found in the patients in the different clinical groups. The presence of an IUD does promote colonization of the genital tract by Actinomyces. However, other factors must be considered in the development of pelvic inflammatory disease. The creation of an acidic environment by some bacteria, such as Lactobacillus, may promote the growth of some pathogens, while inhibiting the growth of others. Furthermore, the insertion of an IUD breaches the protective barrier of the cervical mucus, and the IUD tail creates a transmission link into the uterus.