Genital actinomycosis and intrauterine contraceptive devices. Cytopathologic diagnosis and clinical significance

Abstract

This study from a community hospital documents the relatively frequent occurrence of Actinomyces in 36 women diagnosed by Papanicolaou stained cervicovaginal smears. Actinomyces was identified exclusively in patients wearing an intrauterine or vaginal foreign body (intrauterine devices and pessaries). By using fluorescein isothiocyanate labeled antiserum, the organisms were shown to be Actinomyces israelii in eight randomly selected smears. In five cases Actinomyces was demonstrated in tissues obtained by endocervical and endometrial curettage. Anaerobic microbiologic studies performed in 11 of the 36 cases showed a relatively high rate of recovery of Actinomyces (36.3 per cent) with a yield of four positive cultures. In two cases the isolated organisms were shown to be Actinomyces israelii. In the remaining two cases the exact species of Actinomyces has remained uncertain. Of the 36 patients with smear evidence of Actinomyces, nine (25 per cent) had pelvic inflammatory disease, a rate that appears to be much higher than the already high rate among all intrauterine device users. This observation underscores the importance and clinical significance of the finding of Actinomyces in the vaginal smears of intrauterine device users. Papanicolaou stained cervicovaginal smears provide a relatively easy, inexpensive, fast, and highly specific method for the morphologic diagnosis of Actinomyces and allows us to recognize at a relatively early stage a group of patients who are potentially at risk for the development of pelvic inflammatory disease and its associated more severe complications. The hope is that prompt identification of Actinomyces in cervicovaginal smears can help to prevent the more serious infectious complications in intrauterine device users.

PIP: Occurrence of Actinomyces in 36 women (from September 1976-May 1977) diagnosed by Papinocolaou (Pap)-stained cervical smears (total of 9191 smears) is characterized as "relatively frequent," occurring exclusively in those women wearing an IUD or foreign vaginal body (pessaries). Fluorescein isothiocyante labeled antiserum was used to identify Actinomyces israelii in 8 randomly selected smears. In 5 cases, Actinomyces was demonstrated in tissues obtained by endocervical and endometrial curettage. The recovery rate of Actinomyces in anaerobic microbiological cultures was 36.3%, with a yield of 4 positive cultures. Of the 36 patients with smear evidence of the organism, 9 (25%) had pelvic inflammatory diseases (PID); this rate appears to be much higher than the high rate already established for IUD wearers. Pap-stained smears, easily used in a community hospital, provide an easy, inexpensive, fast and highly specific method for morphologically diagnosing Actinomyces, and its use is recommended to recognize at a relatively early stage a group of patients who are potentially at risk for the development of PID.