What are the risks of intrauterine device (IUD) insertion in women with sexually transmitted diseases?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Notably, presence of newly diagnosed gonorrhea or chlamydia infection is not an indication for IUD removal. [16, 17, 18] The American College of Obstetricians and Gynecologists (ACOG) recommends a preinsertion physical examination to evaluate for signs of cervicitis and screening tests for gonorrhea or chlamydia in high-risk women. If cervicitis is suspected based on physical examination, IUD insertion should be delayed until after treatment. Otherwise, screening may be performed and the IUD inserted on the same day.

If this screen returns positive for gonorrhea or chlamydia, the patient can be treated with the IUD in place. Concern in this setting is for ascending genital tract infection or pelvic inflammatory disease (PID) and related sequelae. The risk for PID related to IUD insertion is greatest within the first 20 days after insertion, indicating that the likely mechanism of infection is contamination of upper genital tract from infection present at the time of insertion. [19, 20]

This underscores the need for screening in high-risk women. The risk for PID in women with a sexually transmitted infection at time of insertion is higher than in women without infection at the time of insertion; however the overall risk is still low, around 5%. [21] Although placing an IUD is contraindicated in a patient with PID, if they acquire PID with an IUD in place treating without removing the IUD is safe. [17, 18] In this situation, patients should be followed closely, and the IUD should be removed if appropriate clinical improvement does not occur. IUDs should be removed in patients with pelvic tuberculosis. [17, 18]


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