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  • Title: Pelvic inflammatory disease and the intrauterine contraceptive device.
    Author: Wright EA, Aisien AO.
    Journal: Int J Gynaecol Obstet; 1989 Feb; 28(2):133-6. PubMed ID: 2563699.
    Abstract:
    The relationship between the use of intrauterine contraceptive device (IUD) and pelvic inflammatory disease (PID) was examined in 1054 patients who were seen at the Family Planning Clinic of Jos University Teaching Hospital and were followed up. The overall risk of PID developing in women wearing the IUD was minimal: 62 out of 1054 (5.9%). The rates, however, varied for the 6-month periods studied. The incidence of PID decreased as the period of usage increased. The greater number of patients developed PID less than 3 months from the date of IUD insertion. When PID occurred it was usually of mild or moderate intensity and the response to antibiotic therapy was very encouraging. There was no relationship between the parity of the patients and the development of PID. Even though there is a definite link between the use of IUD and the development of PID it does not obliterate the benefits which the use of IUD provide for the majority of its patrons; and so the use of IUD should continue. 1054 women who were attending the Family Planning Clinic of Jos University Teaching Hospital (Nigeria) were studied for possible causes of pelvic inflammatory disease (PID) over the May 1983-December 1985 period. 697 women were wearing a Lippes Loop and 357 were wearing a T Cu 200. The IUDs had been inserted by trained nurses using an aseptic technique after careful screening to exclude existing PID. PID was diagnosed primarily by clinical means; fever, acute pelvic pain, vaginal discharge, pelvic tenderness or mass, and a raised white cell count were the symptoms. 62 patients developed PID, 35 with moderate or severe PID needing admission and the remaining 27 with mild PID. The overall incidence of PID in IUD users was 5.9%. During the same period 8 patients developed PID among 533 clients using oral contraceptions. An incidence of 1/30 was recorded for hospitalization of IUD wearers and 1/76 for non-IUD users, giving an incidence 2.5 times greater in IUD wearers. Only 44 patients (4.2%) had used the IUD for over 2 years; only 1 of these patients developed PID, a severe case. There was a decline in the number of patients who developed PID with increased duration of use and the relationship between PID and increased duration of use was significant. The response to chemotherapy was dramatic; only 1 course of therapy was necessary for all patients but 2 who required a subsequent course of tetracycline for complete resolution. There was no relationship between the parity of patients and their developing PID.
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