1B 1 Provision of Intrauterine Devices in an STD Clinic Setting

Tuesday, June 10, 2014: 10:45 AM
Grace Alfonsi, MD1, Jeffrey Eggert, MPH/MBA2, Melissa Edel, RN2, Deborah Bell, WHNP-BC, ND3, Christie Mettenbrink, MSPH4 and Judith Shlay, MD, MSPH5, 1Denver Public Health, Denver Health and Hospital Authority, Denver, CO, 2HIV/STD Prevention and Control, Denver Public Health, Denver, CO, 3Denver Metro Health (STD) Clinic, Denver Public Health, Denver, CO, 4Public Health Informatics, Denver Public Health, Denver, CO, 5Denver Public Health, Denver Health and Hospital Authority, Denver, CO

Background: Most STD clinics focus solely on STD treatment and prevention. However, certain women presenting for care are also at high-risk for unintended pregnancy. Intrauterine devices (IUDs) are highly effective in preventing pregnancy. There is no information on adverse outcomes associated with IUD use in sexually transmitted disease (STD) clinics. This study describes the utilization of IUDs in an STD clinic and evaluates the risk of pelvic inflammatory disease (PID) and discontinuation after insertion.

Methods:   Retrospective chart review of IUD provision at the Denver Metro Health (STD) clinic from January 2011-June 2013. STD screening (gonorrhea and chlamydia [CT] PCR testing) was performed within 45 days of insertion and positive tests were treated prior to insertion.  PID incidence defined per the STD treatment guidelines and IUD discontinuation rate within 90 days of insertion were assessed.

Results: Among 7,427 female clients seen for family planning services (FPS), 404 women had an IUD (5.4%) inserted. Women obtaining IUDs were slightly older than the other FPS patients (mean 28.3 years versus 26.5 years, p<0.001); no other demographic characteristics differed between the two groups. Prior to insertion, 3.4% (14) women had a positive STD screening within 45 days of insertion and were treated.  PID incidence rate was 0.74% (3) at 90 days post insertion and discontinuation rate was 2.5% (10).

Conclusions: Provision of IUDs in an STD clinic setting is feasible. Baseline STDs, risk of PID, and discontinuation after an IUD insertion were similar to other clinical settings (e.g., family planning clinics) and offers an opportunity to provide comprehensive reproductive healthcare in STD clinic settings. Based on these findings, same day IUD insertions likely have minimal risk in STD clinics and could be provided as in other clinical settings