Provision of Same-Day Intrauterine Devices in an STD Clinic

Background:Many women presenting for care at STD clinics are at risk for unintended pregnancy. Intrauterine devices (IUDs) are highly effective in preventing pregnancy but availability in an STD clinic has been limited because of fear of increasing risk of PID caused by an asymptomatic STD.  This study describes the utilization of same -day IUD insertions in an STD clinic and evaluates the risk of pelvic inflammatory disease (PID) in women who receive same- day IUDs compared to women who are pre-screened for STD’s prior to insertion.  

Methods: Retrospective chart review of IUD provision at the Denver Metro Health (STD) clinic from January 2014-December 2015. Comparison was made between women who had gonorrhea and chlamydia PCR (GC/CT) screening done within 45 days of insertion to women who received an IUD and GC/CT screening on the same day.  Positive tests were treated at least 7 days prior to insertion in the pre-screened group or within 14 days after insertion in the same-day insert group.   Incident rate of PID within 90 days of insertion were assessed. 

Results: Among 4,136 female clients seen for family planning services, 274 women had an IUD (6.6%) inserted.  There were slightly more same- day vs multiple- visit IUDs ( 51 vs 49%, p=0.16). Women >26  were somewhat  more likely to receive a same- day IUD compared to  women who were <25( 57% vs 42%, p=0.02)   Incident GC/CT was similar in both groups 11/134 (8%) in the multi-visit vs 10/141 (7%) in the same-day group.   No cases of PID were diagnosed within 90 days of insertion in the multi-visit group, 1 case was diagnosed in the same- day group. (0.71%)

Conclusions: Same-day IUD insertion in an STD clinic setting is feasible and can be done safely without increasing risk of adverse outcomes such as PID.