Clinician Question:  Treating Chlamydia with an IUD in place

I ordered a gonorrhea/chlamydia test for my asymptomatic 17-year-old patient the day I inserted her progestin IUD.  The chlamydia test was positive.  I treated her and her partner with azithromycin.  I left the IUD in place.  Does my patient need a test of cure?  If so, when?

Dr. Anjna Ganatra - New York, NY

Contraceptive Pearl Answer:

First of all, kudos to you for leaving your patient's IUD in place!  Many clinicians remove an IUD when treating cervicitis.  This is unnecessary and counterproductive.  Prompt treatment for your patient and her partner/s is the key to prevention of pelvic inflammatory disease and future infertility.

After initial treatment for chlamydia, your patient does not need a test of cure.  However, because re-infection is common within a few months of initial treatment, you should advise your patient to return for a repeat chlamydia test in about 3 months.  If she doesn't come back for re-testing, you should test her whenever she happens to return.

We appreciate your feedback! Please write us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.

Helpful Resources

Medical Eligibility for Initiating Contraception

IUD Facts Patient Information sheet

Sources

CDC Chlamydia treatment guidelines

Mohllajee AP, Curtis KM, Peterson HB.  Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review.  Contraception.  2006 Feb; 73(2)): 145-53.  Epub 2005 Oct 19.