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Abstract
Intrauterine devices (IUDs) are highly effective, long-term methods of contraception; and it is also very cost-effective. It is one of the most popular methods of contraception being used by more than 80 million women worldwide, and its effectiveness rivals that of tubal sterilization.
However, there are concerns about increased risk of pelvic inflammatory disease (PID) and subsequent complications, such as infertility and ectopic pregnancy, among the IUD users. Some researchers have speculated that the presence of an IUD in the uterus may increase host susceptibility to infection, thus increasing the incidence of PID infections.
Indeed, IUDs are considered to cause PID by pushing vaginal and cervical bacteria into the uterus along the tail of the device. Micro-organisms originating from the normal cervico-vaginal flora then colonize these devices and form biofilms consisting of layers of host cells and bacteria/fungi embedded within a matrix material. The main component of the biofilm produced by the bacteria and/or fungi is an exopolysaccharide layer, which is the pivotal factor responsible for the behaviour of biomaterial centered infection. The biofilm bacteria are usually resistant to attack by antimicrobial agents and host phagocytes. This is one reason why infections caused by these micro-organisms are hard to treat without removal of the devices.
The aim of the present study is to detect the presence of microbial biofilms on copper intra-uterine devices, to characterize the microorganisms associated with these biofilms and to correlate these finding with patient symptoms and microbiological study of the vagina.
In the present study the sample size consisted of 50 women who want to remove IUD randomly selected and we included only married, parous women, who were only in a stable long term relationship. Moreover, they were sharing nearly the same personal hygiene and sexual behavior; so, we can presume that they were probably at allow risk for sexually transmitted diseases.
- In this study we found that, the age ranged between 21-48 with a mean of 33.27.2 years, weight ranged between 50-120 with a mean of 74.217.0.
- In this study we found that, 34 of the studied samples were VD, while 17 were cesarean section.
- We found in our result more than half removal IUD because backache, 30.0% bilateral abdo-minal pain, 28.0% dysmenorrheal, 10.0% bleeding, 28.0% itching, 6.0% menorrhagia, 76.0% vaginal discharge, and 22% were want to get pregnant.
- In this study we found distribution of the studied patients regarding the previous contraception used were found that, the highest value were presented for loop.
- In our result we found that more than half of the studied patients were negative biofilm, while 48.0% were moderate biofilm.
- In our result we found, there were highly statistical significant correlation between the biofilm by colorimetric results and duration of IUD in situ.
- This study found no statistical significant correlation between biofilm by colorimetric results and cause of IUD removal.
- This study found statistical significant differ-rences between biofilm by colorimetric results and previous contraception used, while there were no statistical significant differences bet-ween them regarding injection, OCP and con-dom respectively.
- In our study we found, 77.8% and 22.2% negative and moderate biofilm for age less than 25 years, 30.0% and 70.0% negative and moderate respect-tively for age 40 or more, there were highly statistical significant correlation between them, while there were no statistical significant correlation between biofilm and other ages.
- In this study, there were highly statistical significant correlation between the type of bacterial isolated from IUD culture and that isolated from vaginal culture.
- In our result we found, highly statistical significant differences between PID incidence and duration of IUD with a percentage of 8.0, 20.0 and 80.0% for less than 5 years, from 5-10 years and more than 10 years respectively.
- In this study, 80.0% positive PID was moderate, while 40.0% negative PID were moderate. There were statistical significant differences between them.
- In our IUD culture, gram positive were found in 71.4%, gram negative were found in 28.6%, while aerobic organisms were found in 74.6% and an aerobic were found in 25.4%. On the other hand, were not found any fungal infection in the studied IUD samples.
In our vaginal culture, gram positive were found in 45.3%, gram negative were found in 54.7%, aerobic organisms were found in 64.3%, an aerobic were found in 15.5%, while fungal infection were found in 20.0%.
Finally, we found 96% positive biofilm by colorometric method was positive biofilm by scanning electron microscope while 4% negative biofilm by colorimetric method was positive biofilm by scanning electron microscope. There were no statistical significant correlation between them.