Actinomyces israelii in the female genital tract: a review.

Actinomyces israelii (a gram-positive, branching, anaerobic or microaerophilic bacterium) infects 1.6-11.6% of IUD users worldwide. Physicians must decide whether to treat A. israelii infection with antibiotics, remove the IUD, or refer the patient to the family planning clinic. Culture techniques tend to be inadequate, so many US health professionals use a microscope to identify A. israelii and often confirm the microscopy findings with direct immunofluorescent techniques. A sophisticated culture from pelvic infection or abscesses is needed. It appears that A. israelii infection is more common in women with plastic IUDs than those with copper IUDs and in women who have had an IUD for more than 4 years. Pelvic actinomycotic disease occurs infrequently, but when it does this condition the right ovary and fallopian tube are generally involved; this condition can be life threatening. It is indistinguishable from other forms of pelvic inflammatory disease. Evidence suggests that there is a cause-and-effect relationship between IUD use and pelvic actinomycosis. It is difficult to predict which IUD users harboring A. israelii will develop subsequent serious pelvic infection. Nevertheless, Pap smears can detect A. israelii infection early so physicians can prophylactically treat it before it spreads. Prophylactic treatment in IUD users may consist of changing the IUD every 4 years of long term penicillin or doxycycline treatment. Combinations of various antibiotics used to treat actinomyces infection are penicillin, aminoglycoside, chloramphenicol, amoxycillin, metronidazole, and doxycycline. In the case of tubo-ovarian abscesses larger than 8 cm in diameter, however, surgical treatment is warranted.