Jim Shelton's Pearls

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December 08, 2003

IUDs and STI risk

The news that IUDs are now recommended by WHO for HIV+ women is very useful, but what about risk of sexually transmitted diseases. We tend to shy away from IUDs in our program because we believe risk of STIs is high.

Notably,WHO has also recently shifted it's guidance on increased STI risk and IUDs, which allows for greater access. Only women with a "very high individual risk of exposure" to gonorrhea or chlamydia are classified as Category 3. So "shying away" from IUDs in the manner you describe is probably not warranted.

The WHO position was made recognizing that women at increased risk of STIs and who receive IUDs are at risk of pelvic inflammatory disease, especially in the first few weeks following insertion. However, calculations indicate that the attributable risk resulting specifically from the IUD is relatively small. Furthermore, a recent well-conducted study found no increased risk of subsequent infertility overall among former IUD users.

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The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)

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