Intrauterine devices (IUDs) provide effective contraception and may even lower cancer risk, but these convenient bits of kit worn inside the uterus do carry some risks. One such risk came true for a woman whose IUD was left in for 20 years, leading to a serious infection known as actinomycosis.
After suffering from abdominal pain and fevers, the patient presented to doctors who found that the device had become infected and surrounded with abscesses, triggered by the Actinomyces israelii bacteria. Fortunately, the infection could be treated with a course of antibiotics – but the case report, published in the New England Journal of Medicine, demonstrates the importance of replacing IUDs ahead of their expiry date.
The woman in question was 54 years old and had been suffering from weight loss, pain, fevers, and difficulty walking for a couple of months before presenting to the emergency room. A physical exam revealed a lump in the lower left quadrant of her abdomen which was tender to touch, so the doctors ordered a CT and bloodwork. The CT showed a collection of abscesses around the IUD, which was still in her uterus The blood results supported the presence of infection as the number of white blood cells – which fight infection – was elevated. The infection had spread beyond the pelvis and into the left hip joint.
A. israelii actinomyces are found in the vaginal tracts of even healthy people, but under the right (or wrong) conditions they can cross a boundary and form an active infection known as actinomycosis. The bacteria are characterized by sulfur-colored granules and while a nasty, chronic, and sometimes serious condition, it can be treated with a hefty course of antibiotics.
Once sample analyses confirmed the culprit encasing the woman’s out-of-date IUD to be A. israelii, she was given an extensive course of antibiotics and was reported to have recovered without lasting complications. The IUD in question was plastic and should have been removed after five years, meaning it extended its stay by 15 years. The longest-lasting IUDs are copper coils, but even these should be replaced sooner than 12 years. Beyond increasing the risk of infections such as actinomycosis, out-of-date devices also become ineffective as a form of contraception.
“Pelvic actinomycosis occurs in more than 85% of cases where the IUD has been used for more than 3 years and is more common in users of plastic IUDs than copper IUDs,” said study author Noriko Arakaki to Gizmodo. “We consider that the long-term use of IUDs is a factor in this case.”
“Secondly, it is important that the patient understands that the IUD must be used properly, that regular outpatient visits are necessary, and that it must be replaced at the appropriate time.”