By Rebecca H. Allen, MD, MPH
Assistant Professor, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, RI
SYNOPSIS: A two-year prospective trial of 1,714 women shows an exceedingly low risk of infection following same-day intrauterine device insertion and chlamydia/gonorrhea testing.
SOURCE: Turok DK, Eisenberg DL, Teal SB, et al. A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement. Am J Obstet Gynecol 2016; [Epub ahead of print].
The current study, ran in the U.S. as an analysis of a multicenter, Phase III clinical trial, discerns the risk of infection after same-day administration of sexually transmitted infection (STI) testing and insertion of the 52 mg levonorgestrel intrauterine device (IUD). Women (ages 16-45) seeking levonorgestrel were sampled by researchers at 29 different sites. Enrollment requirements stipulated women could not participate in the study if they had a history of pelvic inflammatory disease, active cervical infection or a recent vaginal infection. The women also must have been monogamous at baseline, but could change sexual partners during the course of the trial.
The trial design called for same-day STI testing on cervical, vaginal or urine samples before the insertion of an IUD. Each participant was screened for chlamydia (CT), while women who had not received testing for gonorrhea (GC) since the start of their most recent sexual relationship received GC tests. Following the insertion of the IUDs, follow-up appointments were scheduled after the first, third and sixth months, with an appointment scheduled once for every six months afterwards. The appointments assessed use and success of IUDs, as well as the potential effects of changes in sexual partners. Upon report of a new sexual partner, women were again screened for CT/GC.
Of the total 1,714 women with IUDs analyzed, 1,687 (98%) received CT screening, while 1401 (81%) received GC screening. 29 of the women received a positive test result (25 testing positive for CT, 3 for GC and 1 for both). Only 6 of these women knew the outcome of the results prior to the insertion of the IUD. In each case of discovered STI, the women were treated with outpatient antibiotics according to CDC guidelines. None of the 29 had their IUD removed. In the two years of follow-up just 9 (.5%) women were diagnosed with pelvic infections, 3 of which were deemed mild infections and 6 of which were deemed severe infections. Seven women received outpatient antibiotic treatment; the other two were treated in-hospital. For three participants, the pelvic infections occurred within a week of insertion, while one patient was diagnosed on day 39 after the IUD insertion. The remaining five patients that experienced infection were all diagnosed more than 6 months following IUD insertion. The author concluded the analysis by determining there is a very low risk of infection following same-day STI testing and IUD insertion.