Pelvic inflammatory disease after IUD insertion
Pelvic inflammatory disease (PID) after IUD insertion is only a risk in the first 20 days after insertion. PID occurring after this time is likely to be caused by a sexually transmitted infection (STI), and not a consequence of IUD insertion.
For investigation and management of PID following IUD insertion, see Assessment of pelvic inflammatory disease and Approach to managing pelvic inflammatory disease.
If infection occurs within the first 20 days after IUD insertion and STI cannot be reliably excluded (eg screening for an STI was not performed before IUD insertion, or an STI could have been contracted after screening), treat as for STI-related PID. If STI has been reliably excluded, treat as for procedure-related endometritis.
If infection occurs more than 20 days after IUD insertion, treat as for STI-related PID (see Treatment of pelvic inflammatory disease). If infection with Actinomyces species is suspected in someone with a long-term IUD, seek expert advice1.
Removal of the IUD is not required unless infection is severe or there is no clinical improvement within 48 to 72 hours of starting therapy. The IUD must not be removed until at least 48 hours of antibiotic therapy has been given. If the IUD is removed, a new device can be inserted once the infection has resolved.