The risk for developing pelvic inflammatory disease (PID) following an intrauterine device (IUD) insertion is low, irrespective of whether a woman has been screened beforehand for gonorrhea and Chlamydia, research findings show.
The results, published in Obstetrics and Gynecology, are in stark contrast to the currently held perception by many patients that IUDs cause PID, especially in women with asymptomatic gonorrhea or Chlamydia, both risk factors for PID, say researchers.
"This study affirms that there is a low risk of PID after IUD insertion, which has the potential to reduce barriers to IUD access, such as making women have a separate screening visit before the IUD insertion," said lead author Carolyn Sufrin (University of California, San Francisco, USA) in a press statement.
"In addition, it provides evidence to support [Centers for Disease Control and Prevention] screening guidelines for gonorrhea and chlamydia in women receiving IUDs," explained co-author Debbie Postlethwaite (Kaiser Permanente Division of Research, Oakland, California, USA). "If testing is indicated, our results suggest that it is safe to do so on the day of IUD insertion, with prompt treatment of positive results."
The retrospective study of 57,728 IUD insertions between 2005 and 2009 at Kaiser Permanente Northern California revealed that 47% of women were not screened for Neisseria gonorrhea and Chlamydia trachomatis within 1 year of IUD insertion. Of women who were screened for these infections, 19% were screened on the same day.
The overall risk for PID was 0.54%. The risk for PID with nonscreening was equivalent to that for any screening (negative risk difference of 0.0034), indicating that women who were not screened had the same risk for PID as those who were. Timing of screening also made little difference to PID risk, with risks associated with screening on the same day as IUD insertion being the same as those of screening beforehand (negative risk difference of 0.0031).
The use of IUDs is low in the USA, which researchers attribute to the poor design of the Dalkon Shield IUD (AH Robins, New Jersey, USA) in the 1970s. Insertion of this IUD led to bacterial infection and thousands of lawsuits. However, Sufrin and team hope that the findings of their study will allay women's fears about the risk for PID associated with IUDs.
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