Prevention of IUD-related pelvic infection: the efficacy of prophylactic doxycycline at IUD insertion

Abstract

It is believed that much of the small increased risk for developing pelvic inflammatory disease (PID) associated with the use of an intrauterine device (IUD) appears to be caused by bacterial contamination of the endometrial cavity at the time of insertion. Previous research suggests that use of prophylactic antibiotics immediately prior to IUD insertion may reduce the risk of developing PID. This paper presents results from a randomized clinical trial of 1485 women in Ibadan, Nigeria evaluating the effectiveness of 200 mg of doxycycline (versus placebo) given orally at the time of IUD insertion in reducing the incidence of PID during the first three months of IUD use. Rate of PID infection in the doxycycline-treated group was not significantly lower than that in the placebo-treated group. The rate of unscheduled IUD-related visits to the clinic also was not significantly lower among the doxycycline-treated group. However, the incidence of PID was low (21 cases) for both study groups. Aseptic conditions during IUD insertion, follow-up visits with short intervals to monitor health, and treatment of opportunistic infections may have reduced the potential of PID within this population.

Intrauterine Contraceptive Devices and Risk of Pelvic Inflammatory Disease

“…[11][12][13] Within this approximately 20-fold range should lie some explanation for why the IUD is a significantly lower-risk method of contraception in some settings than in others. At least two factors -the background prevalence of STI and the conditions under which the procedure is performed -influence the risk of PID following IUD insertion.…”

“…[10][11][12][13] In these series, specific but insensitive PID case definitions requiring three signs of tenderness (abdominal, cervical motion and adnexal) plus evidence of lower genital tract inflammation or fever were used. The studies were conducted under research conditions in university teaching hospitals with better-than-average hygienic conditions and careful selection of IUD candidates.…”

Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review

“…In a 5-year follow-up study in eight developing countries, the rate of acute PID among users of the copper IUD was 0.6 per 1000 womanyears [18]. In randomized controlled trials of prophylactic use of antibiotics at IUD insertion, PID among the placebo group with IUD insertion has been rare, even in populations with high background prevalence of STIs -1.11% in Nigeria at 30 days after insertion [19] and 1.9% in Kenya at 1 month after insertion [6].…”

Pelvic inflammatory disease and intrauterine devices: Prophylactic antibiotics to reduce febrile complications

“…The most important complication is pelvic inflammatory disease (PID). Several studies have been done and several suggestions have been proposed for this [6][7][8]; prophylactic antibiotic at the time of IUD insertion has been advised to reduce PID occurrence [2,3,9]. Doxycycline has been studied to determine whether prophylactic antibiotic could alter the PID occurrence and febrile complications.…”