THE RISK OF INADVERTENT INTRAUTERINE-DEVICE INSERTION IN WOMEN CARRIERS OF ENDOCERVICAL CHLAMYDIA-TRACHOMATIS

The most important complication attributed to the use of intrauterine device (IUD) is pelvic inflammatory disease (PID), often associated wi th Neisseria or Chlamydia infection. Consequently, the IUD should not be inserted in women at risk of infection or with symptoms of endocerv icitis. To evaluate the effectiveness of such a policy, a systematic i nvestigation of Chlamydia and Neisseria was carried out among 407 cont raceptive accepters. Twenty-seven cases were positive for Chlamydia an d none were positive for Neisseria. There were no statistical differen ces in the proportion of women with and without Chlamydia who had vulv ovaginal or cervical signs or symptoms, although twice as many women h ad pain at pelvic exam in the Chlamydia-infected group. In 29 women in whom infection was clinically suspected, two were found to be infecte d with Chlamydia. IUD were not inserted in women suspected of having i nfection, but 19 of 327 IUD accepters were subsequently found to have a positive Chlamydia test result. Two women returned with symptoms of PID and 17 were asymptomatic, but all were treated. PID was not suspec ted in any other subject. These results reinforce the need for careful selection of IUD accepters and for thorough counseling for symptoms o f PID and the need for immediate consultation. (C) 1998 Elsevier Scien ce Inc. All rights reserved.