IUD-Related Actinomyces — SCE Infectious Diseases MCQ

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ModerateSTIsIUD-Related ActinomycesSCE Infectious Diseases

A 28-year-old woman presents with severe lower abdominal pain and vaginal discharge. She has a temperature of 38.5°C and cervical excitation tenderness. NAAT is negative for Chlamydia and Gonorrhoea. She has an IUD in situ inserted 3 weeks ago. What organism is classically associated with IUD-related PID?

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Correct answer: B — Actinomyces israelii

Actinomyces israelii is classically associated with IUD-related pelvic infections. It forms part of the normal vaginal flora but can become pathogenic in the presence of a foreign body (IUD) through biofilm formation. The clinical spectrum ranges from asymptomatic colonisation (Actinomyces-like organisms on cervical smear — does not require treatment if asymptomatic) to severe pelvic actinomycosis with tubo-ovarian abscess. When symptomatic, treatment includes IUD removal plus prolonged antibiotics (IV then oral Amoxicillin, total 6–12 months for established pelvic actinomycosis).

Reference: BASHH 2019 – PID; FSRH 2024 – IUC and Actinomyces; BSAC 2017