Actinomyces and an unidentified ameba associated with an intrauterine device.

Abstract

A case report is presented of an asymptomatic 29-year-old Hawaiian patient with an IUD who had Actinomyces and an unidentified ameba in a Papanicolaou smear and in whom both organisms disappeared upon removal of the IUD. The patient presented for a routine pelvic examination as part of an employment physical. She denied any significant gastrointestinal or vaginal symptoms as well as any history of foreign travel. The patient reported that she had worn the same IUD for 9 years and that it had caused her no discomfort. A pelvic examination revealed a friable, papular cervix. The Papanicolaou smear revealed the presence of both amebae and colonies of Actinomyces. The findings were confirmed by the Armed Forces Institute of Pathology, which reported an intense, acute and chronic inflammatory reaction marked by the presence of amebae and Actinomyces species colonies. The patient returned 4 months later for a repeat pelvic examination and removal of her IUD. At that time a cervical smear showed only amebae. The patient was seen again 3 months following the IUD removal. She reported that her vaginal discharge had decreased. A repeat Papanicolaou smear was completely normal. Faulkner and Ory have reported a 5-fold increase of pelvic inflammatory disease among IUD users compared to nonusers. Among pelvic infections found to be associated with IUD users is genital actinomycosis. Many of these patients are asymptomatic with only cytologic evidence of Actinomyces, but these patients can progress to pelvic inflammation and abscess formation. Reports have recently described the presence of amebic trophozoites in IUD users. The main purpose in reporting this case is to alert the tropical medicine specialist to this entity. Amebic colonization appears to respond completely to IUD removal, and there is no need for additional medical or surgical treatment.