Intrauterine devices (IUDs) are considered effective and well-tolerated methods of contraception. Medical researchers contend that women in the United States are afraid of using them because they think there is a risk of acquiring a pelvic infection. The researchers explain that the risk of an IUD causing a pelvic infection is low and that sexually transmitted diseases, particularly gonorrhea and chlamydia, are usually the cause of pelvic inflammatory disease (PID).
Researchers at the University of California, San Francisco, and Kaiser Permanente’s Walnut Creek Medical Center in California, evaluated the relationship between Neisseria gonorrhea and Chlamydia trachomatis screening strategies and the risk of PID after IUD insertion. They conducted a retrospective study of all IUD insertions at Kaiser Permanente’s facilities in Northern California from January 2005 to August 2009. The researchers compared PID incidence within 90 days after insertion among women who had been screened for both gonorrhea and chlamydia and those who had not been screened, and calculated the risk difference. Results indicated that out of 57,728 IUD insertions, 47 percent were not screened within one year of insertion. Of the women who were screened, 19 percent were screened on the same day. The risk of PID was 0.54 percent. Nonscreening had an equivalent risk of PID as screening, and same-day screening was equivalent to prescreening. The equivalence persisted when adjustments were made for age and race and when results were stratified by ages younger than 26 years and older than 26 years.
The researchers concluded that the risk of PID in women receiving IUDs was low and that the results support IUD insertion with clinicians testing women for gonorrhea and chlamydia based on risk factors, and the test may be performed on the day of insertion.
The study, “Neisseria gonorrhea and Chlamydia trachomatis screening at Intrauterine Device Insertion and Pelvic Inflammatory Disease,” is published in the journal Obstetrics and Gynecology, (2012; 120(6): 1314–1321.