> Spiral contraceptive devices (IUDS): risk of infections to a minimum, unnecessary preliminary examinations

Spiral, summary of the study and prospects

the Spiral, the main points of the study

Spiral, and clinical implications

In every way the authors of this study explain that the risk of PID after the placement of a IUD caused by asymptomatic infection of Neisseria Gonorrhea or Chlamydia trachomatis è less than 5% after two weeks from the plant.

The American College of Obstetrician and Gynecologist is not recommended to do a routine screening for the Gonorrhea and Chlamydia T. before inserting an IUD.

Only when clinicians believe that it is indicated to do the screening must be done, but this può be run on the same day of the introduction of the IUD, even if this approach has been checked in a few studies with a low number of patients.

Spiral, summary of the study and prospects

women who choose to be insert an IUD have a low risk of developing PID, whether they did or not screening for Chlamydia and Gonorrhea before insertion of the IUD, in agreement with the results of a recently published study, on about 60,000 women.

The study is published in the December issue of the journal of Obstetrics and Gynecology.

Carolyn Sufrined his colleagues in the department of Obstetrics and Gynecology and of the Science of Reproduction at the Università of California at San Francisco, says that their results should reassure physicians that the use of the IUD is not; that can be associated to a disease, PID.

note how the use of the IUD è among the più effective più tolerated methods of contraception female. Despite the fact that thereò, they write, the use of the IUD in the United States is limited, mainly because of the widespread misunderstanding that the IUD can cause PID.

because of this misunderstanding,  many health care facilities require patients who wish to make use of an IUD to undergo testing for N. Gonorrhea and T. Chlamydia before the use of IUDS.

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The implementation of this policy makes it very often necessary to consult a specialist.

To check more carefully the results of the study on the possible association between IUD use and PID dr. Sufrine  and colleagues conducted a retrospective study of 57.728 women that have used it and received an IUD in the Kaiser Permanent Northern California Clinic between January 2005 and August 2009.

we Have compared the data and the incidence of PID among women  who have done the screening for T. Chlamydia and N. Gonorrhea before and after the insertion of the IUD, by dividing women into 4 groups :


  1. those who have done the screening on the same day as insertion;
  2. the

  3. those who have done it   between 1 day and 8 weeks before insertion;
  4. the

  5. those that were checked in between 8 weeks and a year before insertion;
  6. the

  7. that have not been checked within a year before the insertion.

The study reports that 47% of women were not controlled within one year prior to insertion of the IUD. About one-fifth (19%) were controlled the same day .

Overall, the risk of having a PID among women controlled is the state of 0.54% (95% CONFIDENCE INTERVAL [CI] 0.48% – O 60% ).

The risk è was più highest among women with control carried out between 1 day and 8 weeks before insertion (0.99; – 95% CI ; 0.82% – 1.20% ) but the differences were not statistically significant.

Moreover, the risk that the insertion might be associated with a PID  has not presented differences of the là of the fact that it is women who have not performed screening, or women controlled, the là when the control occurred (the difference risk of 0.0034 % ; – 95% CI ; – 0.0045 up to 0.0022), or the fact that they have been examined on the same day, or in the  the case of screening during a specialist visit prior to the insertion of the IUD ( the difference in risk  è was 0.0031;  95% CI; between 0.0049 and 0.0008).

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These data do not change and remain equivalent even after being reconsidered on the basis of ageà, to breed and after they are verified to work for women under 26 years and those more di26 years.

The authors conclude that research  has potentially demonstrated the effectiveness of the use of the IUD as a contraceptive is highly effective, long-term and not permanent.

Spiral, the main points of the study

All women between 14 and 49 years of age who have received an IUD in the Kaiser Permanente Northern California, through the public system, were taken for the study. All the patients had an IUD , both with Levonorgesterolo or dispositive Copper-T between 2005 and 2009,

The patients who have taken the test for N. gonorrhea or Chlamydia T in the year preceding the insertion of the IUD were classified as “group screening”. The researchers split the “group screening” in relation to the time in which they have performed the test for the sexually  transmitted (STDs)

women who have not done the STD test, were not considered part of the “group screening”.

The più important findings from the study is the diagnosis of PID within 90 days from the insertion of the IUD.

The diagnosis it is based on a specific set of criteria , but from the data on the use of antibiotics for the treatment of PID.

The researchers examined the relationship between the data of screening for STD, and the risk  for the PID.

The data have been adapted in agreement,  età and the race of the patients.

The study group,  included 57.728 women. The age average of the women who did the screening was 29 years, while in group NO-screen the età average was 36 years.

The study group was racially and ethnically differentiated.

overall, the risk of PID within 90 days from the insertion of the IUD is the state of 0.54%.

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The rate of PID in all the group of NO Screen è was of 0.75% and 0.36%.

The difference between these data was not statistically significant.

Among the 30.336 women in the group screen and the screen on the same day of the insertion of the IUD,

the risk of PID has been equivalent to that of the group of screening carried out prior to insertion.

The results of the più important were similar  also in sub-groups determined on the basis of the età.

Spiral, and clinical implications

The American College of Obstetrician and Gynecologist spoke out against routine screening for N. gonorrhea and Chlamydia T before insertion of the IUD.

When on the basis of a clinical assessment it is considered that screening is indicated should be performed on the same day that you insert the IUD.

In the study carried out by Sufrin and his colleagues, the occurrence of PID after IUD insertion is uncommon, and screening for N. Gonorrhea and Chlamydia T, made prior to the posting, not è was able to modify the risk of PID.

screening for the STD, run the same day as the insertion of the IUD, has had data equivalent to that of the risk of PID  made in advance of the insertion.


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March 2003