Actinomyces sp on intrauterine devices from asymptomatic Mexican women.

An
observational study on 96 patients.
To the Editor. The intrauterine device (IUD) is one of the most widely used contraceptive
methods worldwide, mainly based in the foreign body response and the ability to induce
cellular and biochemical changes in endometrium and uterine fluid.

The present

generation of IUD is made up of a variety of materials ranging from copper to all plastic,
with and without hormone release (Progestasert, LNG-20) are also available. More
innovation in design (like Novo T) and choice of materials (T-Cu 380 series, T-Cu-220
series and multiload-375) has since been done. 2
IUDs are known to be associated with a risk of pelvic infection, heavier periods, menstrual
cramps and complication associated with colonization of microbes on these implant
devices.

2,3

Species that most often complicates the IUD include Actinomyces sp, with a

prevalence of 1.1 to , compared with 0.2% of non-IUD users.

In some cases, even in

asymptomatic patients, IUD behaves as a risk factor for invasive actinomycosis. 5

With the aim to determine the prevalence and to evaluate if the duration of the IUD use
increases Actinomyces sp on the devices in asymptomatic women, a microbiological study
was conducted in 96 Mexican women using IUD, from January to July 2013. Gram and
Ziehl Neelsen stains were performed; agar blood and agar thioglycolate were also used, as
well as biochemical tests for Actinomyces sp.; previous analysis was performed through the
automated system for anaerobic Vytek.
Of the total of 96 IUD obtained, 84 (87.5%) were high copper type (TCu380), 4 (4.2%)
LNG-20 (levonorgestrel), 4 (4.2%) Lippes Loop, 2 (2.1%) 220 TCu and 2 (2.1%)

Gravigard. 56 devices (58.4%) had a time of more than 5 years of use (range: 1 month - 32
years, average 7.5 years).
Samples obtained were cultures in blood agar media showed positive Actinomyces sp
(1.04%) in one patient, quantification cutoff was 200 CFU of A. israellii. The type of IUD
was TCu380 (Copper IUD) with 11 years of use. Organisms commonly known as vaginal
cavity biota were also isolated, (e.g. Escherichia coli, Serratia marcescens, Staphylococcus
aureus, Streptococcus anginosus, mainly on TCu380; Escherichia coli and Staphylococcus
aureus in TCu220. Candida was isolated in four TCu380. Lippes Loop, Gravigard and
LNg-20 (levonorgestrel) devices showed no organisms isolated.
Only one positive culture for Actinomyces israelii was obtained (1.04%), even when IUD is
a major risk factor for infection. The positive results for other organisms (Escherichia coli,
Serratia marcescens, Staphylococcus aureus, and Streptococcus anginosus), allow us to
assume that for the development of actinomycosis may be symbiosis of these organisms
and Actinomyces sp, favored by the conditions generated by the IUD use, these factors
promote the growth in appropriate amount of Actinomyces sp and facilitate pelvic
actinomycosis. 4,5
Biofilm formation or grain that can generate Actinomyces sp, which is favored by IUD use,
induces growth on culture media. 5 However, we noted the absence of growth; this is partly
due to the encapsulated structure of the organism.
The results of this study do not differ from those reported in the literature,

3-5

since the

prevalence of Actinomyces sp in the devices studied was only 1.04% and allow us to
assume that the usage time of the device is not a factor that increases its prevalence,

although IUDs increase per se the incidence of pelvic inflammatory disease in 1.6 per 1000
years of use, 6 and thus, more detailed studies are needed with the aim to determine whether
the presence of IUD is a risk factor for actinomycosis on asymptomatic IUD users.
Physicians should warn women using IUD on the possibility of intrauterine infection and
with a positive cervicovaginal swab specimen with Actinomyces sp organisms can remove
the device (although this behavior is controversial), with the possibility of reinserting when
the findings of exudate are negative for these organisms.
References.
1. Gupta PK, Malkani PK, Bhasin K. Cellular response in the uterine cavity after IUD
insertion and structural changes of the IUD. Contraception 1971; 4: 375-84.
2. Pruthi V, Al-Janabi A, Pereira BM. Characterization of biofilm formed on
intrauterine devices. Indian J Med Microbiol 2003; 21(3): 161-5.
3. Kim YJ, Youm J, Kim JH, Jee BC. Actinomyces-like organisms in cervical smears:
the association with intrauterine device and pelvic inflammatory diseases. Obstet
Gynecol Sci 2014; 57(5): 393-6.
4. Pan L. Actinomyces-like organisms infection in intrauterine devices wearers.
Zhonghua Fu Chan Ke Za Zhi 1993; 28(5): 292-4.
5. Chatwani A, Amin-Hanjani S. Incidence of actinomycosis associated with
intrauterine devices. J Reprod Med 1994; 39(8): 585-7.
6. Westrm L. Incidence, prevalence, and trends of acute pelvic inflammatory disease
and its consequences in industrialized countries. Am J Obstet Gynecol 1980; 138(7
Pt 2): 880-92.
Table 1. IUD obtained and duration of use.
Duration
of IUD

TCu380

Mirena

Lippes
loop

Tcu220

Gravigard

Total

use/
IUD type
< 5 Years
6-10

38
32

2
2

0
0

0
0

0
0

40
34

Years
11-15

10

Years
16-20

Years
21-25

Years
26-30

Years
31-35

Years
Total

64

96

Table 2. Organisms obtained from IUD

IUD type
TCu 380

Organisms obtained
Actinomyces Israelii, Staphylococous aureus,
Escherichia coli, Serratia marcescens, Streptococcus

TCu 220
Asa de Lippes
LNg-20 (levonorgestrel)
Gravigard

anginosus, Candida albicans

Staphylococcus aureus, Escherichia coli
None
None
None