Considerations for patients with pelvic infection and an intrauterine contraceptive device

Patients should have been screened for sexually transmissible infections (STIs) before the insertion of an intrauterine contraceptive device (IUD) to avoid introducing pathogens into the upper genital tract during insertion.

Note: For patients with a long-term indwelling IUD who present with symptoms of pelvic inflammatory disease (PID), consider pelvic actinomycosis.

For patients with a long-term indwelling IUD who present with symptoms of pelvic inflammatory disease (PID), consider pelvic actinomycosisFaculty of Sexual & Reproductive Healthcare (FSRH), 2023Garcia-Garcia, 2017.

If a patient with an IUD is diagnosed with a pelvic infection, consider the timing of the infection following the insertion of the IUD and whether sexually transmissible pathogens have been reliably excluded. For management advice, see:

  • Treatment of pelvic inflammatory disease for
    • pelvic infection within the first 20 days after IUD insertion for whom STIs cannot be reliably excluded (eg patient is sexually active and STIs could have been contracted after screening or patient was not investigated for STIs before the procedure)
    • pelvic infection occurring more than 20 days after IUD insertion
  • Treatment of postprocedural pelvic infection for pelvic infection within the first 20 days after IUD insertion for whom STIs have been reliably excluded.

Removal of the IUD is not required unless the infection is severe or there is no clinical improvement within 48 to 72 hours of starting therapyOng, 2023Workowski, 2021. If the IUD is removed, a new device can be inserted once the infection has resolvedFaculty of Sexual & Reproductive Healthcare (FSRH), 2023.