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Infectious Diseases in Obstetrics and Gynecology
Volume 4 (1996), Issue 2, Pages 85-88
http://dx.doi.org/10.1155/S106474499600018X
Gynecological Case Report

Tubo-Ovarian Abscess Formation in Users of Intrauterine Devices Remote From Insertion: A Report of Three Cases

1Department of Obstetrics, Gynecology, and Reproductive Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
2Vanguard Graduate Gynecology Associates, 1740 South Street, Suite 306, Philadelphia, PA 19146, USA

Received 25 March 1996; Accepted 11 June 1996

Copyright © 1996 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The association between tubo-ovarian abscess formation and the presence of an intrauterine device (IUD) is well recognized. It has been suggested that the risk of upper-genital-tract infection is highest during the immediate period following the insertion of an IUD, returning to baseline by 5 months postinsertion. We present 3 cases of women who, 10–21 years after insertion of their IUDs, developed tubo-ovarian abscesses that were not causally related to sexually transmitted diseases (STDs) or actinomycetes.

Cases: Three women, ages 39–47 years, presented to our gynecology service for evaluation of abdominal pain. One woman had bilateral tubo-ovarian abscesses and the other 2 had unilateral tubo-ovarian abscesses. All 3 were IUD users, with an interval from IUD insertion to presentation of 10–21 years. In each case, the cervical cultures for gonorrhea and chlamydia were negative at presentation and the sexual history was not consistent with an STD mode of spread. All 3 women initially received broad-spectrum antibiotics, but 2 eventually required definitive surgical therapy.

Conclusion: Long-term users of IUDs remain at risk for serious, indolent pelvic infections. These women should be counseled by their gynecologists on an ongoing basis as to this persistent risk. Tubo-ovarian abscess should be strongly considered in the differential diagnosis of an IUD user who presents with an adnexal mass, fever, or abdominal pain.