Infections Associated with Intrauterine Devices

Introduction to PID

• The most common infection associated with IUDs is pelvic inflammatory disease (PID), which is a polymicrobial upper genital tract infection involving organisms from the lower genital tract that ascend during the insertion process, as recommended by the Centers for Disease Control and Prevention (CDC) 1, 2, 3

Pathophysiology and Timing

• PID associated with IUDs is polymicrobial, involving the same organisms as non-IUD-related PID, with the risk being highest immediately after IUD insertion, according to the American College of Obstetricians and Gynecologists (ACOG) 3

Causative Organisms

• PID associated with IUDs involves sexually transmitted pathogens, including Chlamydia trachomatis and Neisseria gonorrhoeae, as well as anaerobes and facultative bacteria, as reported by the CDC 3

Critical Clinical Distinction: Actinomyces

• Actinomyces species are very uncommon and typically occur only in two specific settings: when a patient has an infection at the time of IUD insertion or when the IUD is left in place past the recommended removal time, according to the Infectious Diseases Society of America (IDSA) 4
• Actinomyces is NOT the most common infection with IUDs—this is a common misconception, as stated by the IDSA 4

Risk Factors and Prevention

• The absolute risk of PID following IUD insertion is low in women without pre-existing STIs, but significantly elevated in women with cervical infection at insertion, according to the ACOG 3
• Women with current purulent cervicitis, chlamydial infection, or gonorrhea should not have an IUD inserted until infection is treated, as recommended by the ACOG 3

Management of PID in IUD Users

• When PID develops in an IUD user, it is diagnosed and managed as standard PID with appropriate antibiotics, with clinical outcomes not differing whether the IUD is removed or left in place during treatment, according to the ACOG 3