Detection and prevalence of IUD-associated Actinomyces colonization and related morbidity. A prospective study of 69,925 cervical smears.

Cervical Papanicolaou smears from 69,925 women were screened prospectively for the presence of Actinomyces israelii. The organism was not identified in non-intrauterine (contraceptive) device (IUD)-wearers. The prevalence of A israelii among IUD wearers ranged from 1.6% (general population) to 5.3% (clinic population). Protracted IUD use seemed to predispose to a higher incidence of infection. Direct immunofluorescence proved to be a more accurate and specific method of identification when compared with conventional light microscopy and anaerobic culture. Two of 112 women with direct immunofluorescence-proved A israelii had significant clinical infections. It appears that in the vast majority of cases, IUD-associated Actinomyces colonization produces only a superficial infestation. Conservative management is suggested for asymptomatic patients with cytologically detected Actinomyces to include removal of the IUD and repeated Papanicolaou smear after the next menstrual period.