title: A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement.
abstract: BACKGROUND
  Misperceptions persist that intrauterine device placement is related to pelvic infections and Chlamydia and gonorrhea testing results are needed prior to placement.
  
  
  OBJECTIVE
  We sought to evaluate the relationship of Chlamydia and gonorrhea screening to pelvic infection for up to 2 years following placement of the levonorgestrel 52-mg intrauterine system.
  
  
  METHODS
  A total of 1751 nulliparous and multiparous females 16 to 45 years old enrolled in a multicenter trial designed to evaluate the efficacy and safety of a new levonorgestrel intrauterine system for up to 7 years. Participants had Chlamydia screening at study entry and yearly if they were age ≤25 years. Women also had baseline gonorrhea screening if testing had not been performed since starting their current sexual relationship. Those who changed sexual partners during the trial had repeated Chlamydia and gonorrhea testing. Intrauterine system insertion could occur on the same day as screening. Participants did not receive prophylactic antibiotics for intrauterine system placement. Investigators performed pelvic examinations after 12 and 24 months and when clinically indicated during visits at 3, 6, and 18 months after placement and unscheduled visits. Pelvic infection included any clinical diagnosis of pelvic inflammatory disease or endometritis.
  
  
  RESULTS
  Most participants (n = 1364, 79.6%) did not have sexually transmitted infection test results available prior to intrauterine system placement. In all, 29 (1.7%) participants had positive baseline testing for a sexually transmitted infection (Chlamydia, n = 25; gonorrhea, n = 3; both, n = 1); 6 of these participants had known results (all with Chlamydia infection) prior to intrauterine system placement and received treatment before enrollment. The 23 participants whose results were not known at the time of intrauterine system placement received treatment without intrauterine system removal and none developed pelvic infection. The incidence of positive Chlamydia testing was similar among those with and without known test results at the time of intrauterine system placement (1.9% vs 1.5%, respectively, P = .6). Nine (0.5%) participants had a diagnosis of pelvic infection over 2 years after placement, all of whom had negative Chlamydia screening on the day of or within 1 month after intrauterine system placement. Infections were diagnosed in 3 participants within 7 days, 1 at 39 days, and 5 at ≥6 months. Seven participants received outpatient antibiotic treatment and 2 (diagnoses between 6-12 months after placement) received inpatient treatment. Two (0.1%) participants had intrauterine system removal related to infection (at 6 days and at 7 months after placement), both of whom only required outpatient treatment.
  
  
  CONCLUSIONS
  Conducting Chlamydia and gonorrhea testing on the same day as intrauterine system placement is associated with a low risk of pelvic infection (0.2%). Over the first 2 years of intrauterine system use, infections are infrequent and not temporally related to intrauterine system placement. Pelvic infection can be successfully treated in most women with outpatient antibiotics and typically does not require intrauterine system removal. Women without clinical evidence of active infection can have intrauterine system placement and sexually transmitted infection screening, if indicated, on the same day.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
authors.forename: David K
authors.initials: DK
authors.lastname: Turok
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO.
authors.forename: David L
authors.initials: DL
authors.lastname: Eisenberg
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Teal
authors.affiliation: Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Keder
authors.affiliation: Department of Obstetrics and Gynecology, University of California-Davis, Sacramento, CA. Electronic address: mdcreinin@ucdavis.edu.
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Creinin
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D004716:Endometritis / Q000453:epidemiology*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008875:Middle Aged; D034161:Pelvic Infection / Q000453:epidemiology*; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Chlamydia; Liletta; contraception; endometritis; gonorrhea; intrauterine device; intrauterine system; levonorgestrel; pelvic infection; pelvic inflammatory disease