A direct immunofluorescence (IF) method was compared with traditional culture methods for the detection of Actinomyces israelii in endocervical and intra-uterine-device (IUD) smears from 124 IUD wearers. Of 11 specimens that gave positive results by IF, only one was positive by culture. Of the 10 patients with positive IF specimens, three (30%) had signs and symptoms suggestive of pelvic infection and no other pathogen was detected. Direct IF of cervical smears offers a simple, relatively cheap method to screen IUD wearers for A. israelii. Clinical management of such cases is discussed.
PIP: An immunofluorescent microscopic method (IF) was compared with conventional culture methods for detection of Actinomyces israelii in smears from the endocervix and IUD of 124 women over a 4-month period at the Royal Women's Hospital, Melbourne. Genital actinomycosis is a non-contagious, chronic, suppurative infection caused by a slowly growing, filamentous, gram-positive anaerobe, and it can lead to fibrosis, abscess or death. The women, attending the Family Planning, Gynecology or Emergency Departments for termination of contraception, replacement of an IUD or for signs or symptoms of pelvic infection, work plastic or copper IUDs. All were screened for Chlamydia and cervical cytology. Actinomyces cultures were screened for 4 weeks and A. israelii identified by morphology, Gram stain and gas-liquid chromatography. The immunofluorescence method involved pepsin treatment of heat-fixed slides, staining with fluorescein-conjugated antibody to A. israelii types I and II, counter-staining, and examination under fluorescence microscopy. Slides were graded subjectively in comparison with positive and negative controls. 9 (11%) of 82 cervical smears, and 2 (4%) of 49 IUD smears were positive by IF, while only 1 was positive by culture: all from 10 patients. One patient has a positive chlamydia culture, and also symptoms of pelvic infection requiring hospitalization. There were 6 others who had symptoms such as pain and discharge, who were treated with IUD removal and antibiotics. 3 women asymptomatic women merely had their IUDs removed. There were no incidents of severe actinomycosis requiring surgery or prolonged hospital treatment although this infection can in rare case be life-threatening. Management of pelvic actinomycosis was discussed.