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RISK OF PELVIC INFLAMMATORY DISEASE IN IUD CONTRACEPTIVE USERS LOWER THAN FEARED (p 443)

February 07, 2001

The risk of developing full clinical pelvic inflammatory disease (PID) associated with sexually-transmitted infections (STIs) may not be as high as suspected in women using an intra-uterine device (IUD) reports a research letter in this week's issue of THE LANCET.

The IUD is a common method of contraception, although its use varies greatly in different countries. The perceived risk of developing PID in IUD users increases in women who are at risk of STIs such as gonorrhoea and chlamydia. Health-care providers in countries such as Africa (where there is a high incidence of STIs) avoid fitting the IUD, despite its effectiveness as a contraceptive.

James Shelton from the US Agency for International Development, Washington DC, USA, re-evaluated data from previous studies to calculate the risk of developing full clinical PID. He estimates that the risk of developing PID is 0.15% (less than 1 in 600) in a typical African population where the prevalence of gonorrhoea and chlamydia together may be around 10%. In areas with lower STI prevalence, PID risk would be lower. He comments that this estimate does not include the risk of the development of other (more subtle) symptoms, though their risk attributable to the IUD may also be low.

James Shelton comments: "Although PID risk from IUDs is very low, we need to try to reduce it. Health-care managers also need better estimates of STI prevalence among their clientele. Although it has its disadvantages, the IUD offers considerable benefit, including an effectiveness closely similar to that of sterilisation, reversibility, and potential use for over a decade. More women should be offered the IUD as a realistic contraceptive choice. It of course remains important to promote condom use and other behaviour changes to reduce HIV and STI risk regardless of contraceptive choice". (Quote by e-mail; does not appear in published paper).

Contact: Dr James Shelton, Center for Population, Health and Nutrition, US Agency for International Development, Washington DC 20523, USA; T) +1 202 712 0869; E) JShelton@USAID.GOV

Lancet