Pelvic actinomycosis: a forgotten cause of pelvic pain

Area of Science:

• Gynecology
• Infectious Diseases
• Medical Microbiology

Background:

• Actinomycosis is an invasive, suppurative anaerobic infection.
• Pelvic actinomycosis is frequently associated with prolonged intrauterine device (IUD) usage.
• It can present insidiously with symptoms like palpable mass, weight loss, and malaise, often leading to misdiagnosis as malignancy.

Purpose of the Study:

• To provide a comprehensive overview of pelvic actinomycosis.
• To discuss the background, clinical presentation, diagnostic methods, and management strategies.
• To highlight the importance of recognizing this condition to prevent severe sequelae.

Main Methods:

• Literature review and synthesis of existing knowledge on pelvic actinomycosis.
• Analysis of clinical presentations, diagnostic challenges, and treatment outcomes.
• Discussion of management principles including conservative and surgical interventions.

Main Results:

• Pelvic actinomycosis can lead to significant morbidity, including abscess formation, fistula development, and infertility if not promptly treated.
• Misdiagnosis as a malignant process is common due to overlapping clinical and imaging features.
• The cornerstone of management involves IUD removal and prolonged antibiotic therapy (6-12 months).

Conclusions:

• Pelvic actinomycosis is an under-recognized but significant gynecological infection.
• Timely diagnosis and appropriate management, primarily antibiotic treatment and IUD removal, are essential for favorable outcomes.
• Surgical intervention may be necessary in complicated or refractory cases.