Sammanfattning
Pelvic actinomycosis (Ac) is rare and the understanding of its pathogenesis is limited. Actinomyces israelii (Ai) is part of the indigenous genital flora. Identification of Ai in the vagina or cervix is therefore not diagnostic of pelvic Ac. The evidence found no indication for IUD removal or antibiotic treatment when Ai is found in the genital tract of asymptomatic women. Pelvic Ac can mimic pelvic malignancy; for that reason the diagnosis is often made during surgery. The diagnosis can be obtained preoperatively by imaging-guided needle biopsy. Ai is identified by haematoxylin-eosin, Gram stain or Grocott Gomori's stain and confirmed by anaerobic culture for a minimum of five days and if possible immunofluorescent staining. The treatment is a combination of antibiotic treatment, for which penicillin is the drug of choice, surgery and drainage of abscesses. High-dose, long-term antibiotic treatment is necessary.