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  • Title: [The role of intrauterine contraceptive devices in the development of inflammatory processes in the small pelvis].
    Author: Batar I.
    Journal: Orv Hetil; 1986 Aug 10; 127(32):1923-8. PubMed ID: 3763205.
    Abstract:
    The incidence of pelvic inflammatory disease (PID) attributable to IUD use has been increasing, especially after the removal of the Dalkon shield from the market, but this relationship has not been settled conclusively. In recent decades PID included a variety of infections, but lately the definition of PID has meant acute ascending infections of the female genital tract. Its most common risk factors include promiscuity of IUD use, although this can be reduced to one fourth by regular checkups and proper hygiene. The frequency of PID is estimated at 2-5% of IUD users. Microorganisms contributing to PID include Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Escherichia coli, Proteus, Staphylococcus epidermis, Haemophilus influenzae, Bacteroides, Peptococcus, Peptostreptococcus, Clostridium, and Actinomyces israelii, The differentiation of actinomycosis (AC) and pseudoactinomycosis (PAC) is well advised. The potential of IUD use in increasing the risk of AIDS should not be discounted. The clinical picture of PID is varied, it can be mild requiring conservative drug therapy; with medium severity requiring removal of the IUD and drug therapy; severe necessitating removal, antibiotics and sulfonamide treatment and laparotomy; and very severe with potentially fatal generalized sepsis. In addition to antibiotics, e.g., penicillin, treatment can include the so called catastrophy combination of Mandokef- Metronidazol-Gentamycin. An analysis of the data of 8536 IUD fittings in Debrecen, Hungary showed 1.4% removals due to PID after 4 years, 694 patients (8.1%) had lower abdominal pain 73 of which (0.9%) had palpable resistance, and suppuration occurred in only 30 cases (0.4%). Treatment included Semicillin or Tetran, or removal of the IUD, and even surgery if no improvement resulted. Prevention of PID include elimination of risk factors, the careful selection of IUD users, regular checkups, the use of copper (Cu) T device, and strict adherence to professional standards.
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