IUDs safe in population at high risk for STIs

1. In a study population at high-risk for sexually transmitted infections, the rate of pelvic inflammatory disease following intrauterine device placement was low.

2. The IUD continuation rate at one year was greater than 85 percent.

Evidence Rating Level: 3 (Average)       

Study Rundown: Intrauterine devices (IUDs) are some of the most effective forms of birth control, with a failure rate of less than one percent, and have been demonstrated to be safe for a wide range of women, including teenagers and young adults. Despite their high efficacy and safety record, many practitioners and patients still have misconceptions regarding the risk of pelvic inflammatory disease (PID) after IUD placement. PID is an infection of the upper genital tract (endometrium, tubes and ovaries) that commonly occurs when a sexually transmitted infection (STI), such as Chlamydia, gonorrhea, or trhichomonas ascends from the lower genital tract. Complications from PID include infertility and PID as well as an increased risk of ectopic pregnancy. If a woman has an STI at the time of IUD placement, she is at higher risk of contracting PID, but after about 20 days, the risk of PID decreases to the baseline risk among women who use a non-barrier form of contraception. Because of the concern for risk of PID with IUD insertion among women at high risk for STIs, most large studies exclude this population and limited data exists to guide their use in this population. In the present work, researchers retrospectively assessed rates of PID after IUD placement in an urban teaching hospital that did not restrict IUD eligibility based on STI risk factors.

Rates of PID following IUD placement were low and comparable to previous studies. The study population was at high-risk for STIs with a high incidence (nearly 50%) of personal history of STIs, 50% of participants were under the age of 26, and participants identified as being single. Lack of control group limited this study. Replication of findings using an age-matched control cohort would lend credence to the results presented herein.

Click to read the study in Contraception

Relevant Reading: Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review

In-Depth [retrospective cohort]: Researchers reviewed charts of all patients undergoing hormonal IUD placement in the resident clinic of a large, urban, academic medical center from July 2007-June 2008 (n = 283). IUD candidates were not restricted by age, parity or STI risk. The primary outcome was diagnosis of PID within twelve months of IUD placement. Secondary outcomes included continuation and adverse outcomes: expulsion, perforation, pregnancy, pain and heavy bleeding.

Prior to IUD placement, 140 patients (49.5%) reported a history of STI and eight (3.02%) tested positive for gonorrhea or chlamydia at the time of placement in this high-risk population. In the 12 months following placement, only two patients (0.7%) were diagnosed with PID, one of which had a positive gonorrheal test at the time of placement. The continuation rate at one year was 85.2%, expulsion rate was low (5.3%) and a minority of women (17.7%) reported adverse effects.

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