Snapshot A 40-year-old woman presents to her gynecologist for discomfort after having an intrauterine device implanted. She has noted some yellow-tinged fluids when wiping, reports feeling some irritation, and had a low-grade fever. On physical exam, yellow fluid is noted draining from the cervical os. A pap smear is done, which reveals branching filamentous gram + rods. Introduction Classification Actinomyces israelii an anaerobic, branching, filamentous gram + rod produces yellow sulfur-colored granules transmission direct contact with bacteria Associated conditions cervicofacial actinomycosis Epidemiology Demographics male > female Location most commonly affects the face and neck may also cause pelvic inflammatory disease Risk factors poor oral hygiene dental caries dental extraction or procedure dental trauma intrauterine device (IUD) ETIOLOGY Pathogenesis anaerobic environment in abscess cavities allow the bacteria to flourish Presentation Symptoms mass on the face or neck Physical exam may have a fever facial actinomycosis nontender, indurated mass sinus tracts may drain thick yellow pus may contain sulfur granules cervicoactinomycosis may have draining yellow pus from cervical orifice Studies Labs tissue biopsy, culture, or pap smear gram + branching rods not acid-fast microscopy of draining pus yellow granules filled with bacteria Making the diagnosis most cases are clinically diagnosed Differential Nocardiosis distinguishing factors weakly acid fast and aerobic branching filamentous gram + rod primarily causes pulmonary infections that can spread to central nervous system SNAP = Sulfa for Nocardia; Actinomyces use Penicillin Treatment Conservative improved oral hygiene indication all patients Medical penicillin all patients tetracyclines indications penicillin allergy Operative surgical drainage or excision indication all patients along with antibiotics Complications Fistula formation Scarring Prognosis Slowly progressive over weeks to months May relapse even after treatment