Gonorrhea or Chlamydia infection is a risk factor for PID in any woman. There is a concern that inserting an IUD in someone, who has an asymptomatic infection, could increase that risk of PID
The study by the American College of Obstetricians and Gynecologists, also known as Green Journal corrects long-standing misperceptions that IUDs cause PID. Also, by evaluating the relationship between the timing of testing for Gonorrhea and Chlamydia (GC/CT) and the risk of developing PID within 90 days after IUD insertion, the study fills a large gap in the evidence base for the optimal timing and necessity of testing women who have no symptoms of Gonorrhea and Chlamydia.
The researchers explained that IUDs are among the safest, most effective methods of contraception and provide benefits in managing vaginal bleeding, chronic pelvic pain and a condition called endometriosis, which occurs when cells from the lining of the uterus grow in other areas of the body. Whereas the risk of pregnancy is 9 percent annually with pills, patches and rings, IUDs allow women almost complete control in planning their pregnancies.
The date of the IUD insertion visit was compared with the most recent Gonorrhea and Chlamydia screening date to categorize women into four screening groups:
1) Screening on the same day as insertion;
2) Screening one day up to eight weeks before insertion;
3) Screening eight weeks up to one year before insertion; and
4) No screening within one year before insertion.
Although the risk of PID in IUD users is highest in the first 20 days after insertion, 90 days after insertion was chosen as the benchmark in order to be conservative in estimating the risk of PID. PID risks for the Gonorrhea and Chlamydia screening groups were compared by calculating both unadjusted and adjusted risk differences and odds ratios with 95 percent confidence intervals, with adjustments for age and race, factors known to be associated with PID.
The risk of PID diagnosis within 90 days of IUD insertion in the entire cohort was 0.0054. The risk was highest in the group screened one day to eight weeks before insertion and lowest in the group with no screening, indicating that women who were not screened had an equivalent risk of PID as women who were screened.