Doctors in Japan reported this week that an intrauterine device (IUD) left in a woman for more than 20 years may have contributed to a nasty infection that sent her to the emergency room.
The bacteria found on the long-expired birth control device caused her months of fever and abdominal pain. Her symptoms disappeared after the woman’s IUD was removed and she was given a long course of antibiotics.
IUDs are T-shaped devices that are inserted into the uterus and used as long-term birth control. They are about the size of a quarter.
This can occur either as a result of the device’s release of hormones or as a result of the copper used in some products (the copper makes the uterus inhospitable to sperm). IUDs are extremely effective, preventing pregnancies in 99 percent of cases.
They do, however, have drawbacks, as do all medications. For example, the initial insertion procedure can be extremely painful, and some people may experience symptoms such as increased bleeding or cramps in the months following. When they first came out in the 1970s, they were probably a lot less safe than they are now.
Another limitation is that they aren’t designed to last indefinitely. Although different brands have different expiration dates, all IUDs must be replaced or removed after a certain amount of time. Even though a copper IUD has the longest replacement time, users are advised to remove it after 10 to 12 years. Unfortunately, the woman in this case study, which was published on Wednesday in the New England Journal of Medicine, did not.
The 54-year-old woman went to the ER after experiencing symptoms for a long time, according to the report. For the previous two months, she had been suffering from a fever and weight loss, as well as abdominal pain and difficulty walking.
Doctors discovered a tender mass on her lower left abdomen during an examination, and blood tests revealed an elevated white blood cell count, which is a common sign of infection. Doctors discovered the IUD, as well as multiple abscesses (pus-filled pockets of dead tissue, white blood cells, and germs that are a sign of infection) throughout the pelvis and extending out to her left hip joint, during a CT scan of the affected area.
To physically clear as much of the infection as possible, doctors performed surgery to drain the abscesses and wash out the fluid in her hip. The IUD was removed at the same time. The long embedded device was covered in distinctive “sulfur-colored” granules, which are often associated with actinomyces, a rod-shaped bacteria group (the granules are ball-like masses of the bacteria clumped together with pus gunk).
And, sure enough, they were able to isolate the bacteria Actinomyces israelii from fluid samples taken from the woman. Actinomycosis is the name for this type of infection.
Although A. israelii is a common and usually harmless passenger in the vaginal, colon, and mouth, it can cause opportunistic infections on rare occasions. Given that these infections have been linked to IUDs left inside for too long, study author said that the IUD most likely played a role in the woman’s ordeal (not to mention, the device was covered in the bacteria).
The woman’s IUD was plastic, and it should have been replaced after five years at the most, with annual check-ups recommended as well. Despite the fact that the authors did not inquire as to why the woman chose not to replace it as expected, Arakaki stated that she disliked hospitals.
“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,” Arakaki explained. “We consider that the long-term use of IUDs is a factor in this case.”
The woman was then given a long course of IV antibiotics, followed by oral antibiotics. Despite the fact that she is still on oral antibiotics, she is in “good general health with no recurrence of abscesses and no major complications,” according to Arakaki.
The authors hope that their study will prompt other doctors to consider the possibility of actinomycosis in similar cases where pelvic abscesses are discovered, as well as to inquire about their patients’ IUD history. “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,” she continues.