Positive Testing for Neisseria gonorrhoeae and Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease in IUD Users

Abstract

Background: Unintended pregnancies are a major public health problem in the United States, and intrauterine devices (IUDs) are among the most effective reversible birth control methods available. Historically, there have been concerns about IUD use and infection among young and/or high-risk women that may increase the risk of pelvic inflammatory disease (PID) and subsequent infertility. Methods: The Contraceptive CHOICE Project (CHOICE) was a prospective cohort study of over 9,000 women 14-45 years of age residing in the St. Louis area who were interested in initiating a new form of reversible contraception. At enrollment, participants were counseled regarding long-acting contraceptive methods with the goal of increasing awareness of all reversible methods available. Participants were also tested for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) during enrollment and were provided with contraception at no cost for 2-3 years. Results: We estimate the frequency of self-reported PID in new IUD users compared with women using other contraceptive methods. Among both new IUD users who tested positive for GC and/or CT and those who tested negative, the PID rate was 1% or below.Conclusions: Our results demonstrate that IUD use is safe for all women, including women at high risk for sexually transmitted infections.

Long-Acting Reversible Contraception

“…28 More recent studies conducted in the United States have also shown low rates of PID after IUD insertion: less than 1% among 57,728 women within 90 days after IUD insertion, even in the absence of STD screening, 29 and 1% or less among participants in the Contraceptive CHOICE Project. 30 The LNG-IUD may, in fact, protect against PID; a randomized, controlled trial involving 2758 women showed that the risk of PID was lower among LNG-IUD users than among users of a coppercontaining IUD (Nova-T) after 36 months of use. 31 Observational studies have also shown that infertility was associated with a history of STDs and not a history of IUD use.…”

Sexually Transmitted Infections, Pelvic Inflammatory Disease, and the Role from Intrauterine Devices: Myth or Fact?

“…The PID rate was 1% below for the following groups: users who tested positive for CT (Chlamydia trachomatis) and/or GC (Neisseria gonorrhoeae) and those who tested negative [17]. This comprehensive research concluded that even for high-risk women, IUD is a good choice [17]. In another study, Hall [18] also reported very low rates of PID among nulliparous woman using IUD, despite the higher rates of symptoms as cramping or heavy menses for copper IUD users.…”

“…A recent large prospective cohort study called The Contraceptive CHOICE Project (CHOICE) [17] studied 9.000 women looking for a new method of reversible contraception. The frequency of self-reported PID was compared between the IUD users group and the population using other methods of contraception [17].…”

“…The frequency of self-reported PID was compared between the IUD users group and the population using other methods of contraception [17]. The PID rate was 1% below for the following groups: users who tested positive for CT (Chlamydia trachomatis) and/or GC (Neisseria gonorrhoeae) and those who tested negative [17].…”

The safety of intrauterine contraception initiation among women with current asymptomatic cervical infections or at increased risk of sexually transmitted infections

“…A secondary data analysis (level II-2, fair) of a US prospective cohort study examined the rate of PID over 6 months among 4371 Cu-IUD or LNG-IUD initiators compared with 3240 non-IUD contraception initiators (Table 1) [13]. All women were screened for GC/CT at baseline with NAAT, and asymptomatic women initiated the IUD on the same day as screening.…”