Culture- and PCR-based detection of BV associated microbiological profile of the removed IUDs and correlation with the time period of IUD in place and the presence of the symptoms of genital tract infection

András Ádám,Israel David Gabay,Gabriella Terhes,Márta Szűcs,Zoltán Pál,Edit Urbán

doi:10.1186/s12941-018-0293-6

András Ádám, Israel David Gabay + Show 4 more

Open Access

https://doi.org/10.1186/s12941-018-0293-6

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Abstract

ObjectivesThe long-term use of intrauterine devices (IUDs) may lead to biofilm formation on the surface. The aim of this study was to perform the culture- and PCR-based detection of bacteria/fungi from the biofilm of the removed IUDs with different time periods in place.MethodsFor a 2-year period, 100 IUD users were involved in the study. In the majority of the cases, IUDs were removed because of the patients’ complaints. Beside the aerobic and anaerobic culture, species-specific PCR was carried out to detect Chlamydia trachomatis Neisseria gonorrhoeae and the “signalling” bacteria of bacterial vaginosis (BV) in the biofilm removed by vortexing.ResultsSixty-eight percent of IUDs were used for more than 5 years, 32% were removed after 10 years in place. In 28% of the IUDs ≥ 3 different anaerobic species typically found in BV with or without other aerobic bacteria were found by culture method. Streptococcus agalactiae (14%) and Actinomyces spp. (18%) were also isolated frequently. The PCR detection of Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp. and Ureaplasma urealyticum were 62%, 32%, 23% and 16%, respectively. Seventy-six percent of the IUDs were PCR positive at least for one “signalling” bacterium of BV. C. trachomatis was detected by PCR only in one IUD together with other aerobic and anaerobic bacteria, while the presence of N. gonorrhoeae could not be confirmed from the biofilm of these removed devices.ConclusionSexually transmitted infections (STI)-related bacteria—except for one patient—were not detected on the IUDs removed due to different reasons including clinical symptoms of infection. Presence of any BV “signaling” anaerobic bacteria were detected in a much higher number in the biofilm of the removed IUDs by PCR-based method compared to use culture method (76 versus 28 samples). Different aerobic and anaerobic bacteria colonized an equal number of IUDs, independent of the time-period in place, which may be relevant, if the IUD is removed due to planned pregnancy or due to a fear from upper genital tract infection caused by anaerobic bacteria including Actinomyces spp.

Highlights

Nowadays intrauterine devices (IUDs) are accepted as highly effective, long-term methods of contraception
Due to the bad patient’s compliance towards gynecology services in Hungary, we found some extremely “old” IUDs
Results of PCR detection of bacteria from the ultra‐sonicated IUD samples The specificity of species-specific PCR primer pairs used during this study was successfully confirmed with ATCC reference strains for six bacteria considered to be sexually transmitted infections (STI) pathogens (N. gonorrhoeae, C. trachomatis) or frequently found in bacterial vaginosis (BV) (G. vaginalis, A. vaginae, Mobiluncus spp. and U. urealyticum) (Table 1)

Summary

Introduction

Nowadays intrauterine devices (IUDs) are accepted as highly effective, long-term methods of contraception. The normal usage period of an IUD is 4–5 years depending on the manufacturer’s recommendation The use of these devices is usually limited by the concerns about upper-genital-tract infections and forthcoming reproductive health complications [1]. Pelvic inflammatory disease (PID) is the most common gynecological infection, which is associated with high morbidity resulting from inflammation and damage of the reproductive tract. These may lead to severe sequel, such as tubal infertility, ectopic pregnancy and chronic pelvic pain. Where STI microbes are not detected before the insertion of the IUD, several authors emphasize the possible role of aerobic and anaerobic bacteria commonly associated with bacterial vaginosis (BV) as the causative agents behind inflammation of the upper genital tract [5, 6]. The possible association between the development of BV and IUD use could be explained by the increased volume and duration of menstrual flow because of the presence of the device [6]

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