Intrauterine Devices and Sexually Transmitted Infection among Older Adolescents and Young Adults in a Cluster Randomized Trial

• Published in: Journal of pediatric & adolescent gynecology 2021-06, Vol.34 (3), p.355-361
• Main Authors: El Ayadi, Alison M., Rocca, Corinne H., Averbach, Sarah H., Goodman, Suzan, Darney, Philip D., Patel, Ashlesha, Harper, Cynthia C.
• Format: Article
• Language: English
• Subjects: Adolescent; Chlamydia trachomatis; Contraception; Intrauterine device; Neisseria gonorrhoeae; Sexually transmitted diseases
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/j.jpag.2020.11.022

Provider misconceptions regarding intrauterine device (IUD) safety for adolescents and young women can unnecessarily limit contraceptive options offered; we sought to evaluate rates of Neisseria gonorrhoeae or Chlamydia trachomatis (GC/CT) diagnoses among young women who adopted IUDs. Secondary analysis of a cluster-randomized provider educational trial. Forty US-based reproductive health centers. We followed 1350 participants for 12 months aged 18-25 years who sought contraceptive care. The parent study assessed the effect of provider training on evidence-based contraceptive counseling. We assessed incidence of GC/CT diagnoses according to IUD use and sexually transmitted infection risk factors using Cox regression modeling and generalized estimating equations. Two hundred four participants had GC/CT history at baseline; 103 received a new GC/CT diagnosis over the 12-month follow-up period. IUDs were initiated by 194 participants. Incidence of GC/CT diagnosis was 10.0 per 100 person-years during IUD use vs 8.0 otherwise. In adjusted models, IUD use (adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 0.71-2.40), adolescent age (aHR, 1.28; 95% CI, 0.72-2.27), history of GC/CT (aHR, 1.23; 95% CI, 0.75-2.00), and intervention status (aHR, 1.12; 95% CI, 0.74-1.71) were not associated with GC/CT diagnosis; however, new GC/CT diagnosis rates were significantly higher among individuals who reported multiple partners at baseline (aHR, 2.0; 95% CI, 1.34-2.98). In this young study population with GC/CT history, this use of IUDs was safe and did not lead to increased GC/CT diagnoses. However, results highlighted the importance of dual sexually transmitted infection and pregnancy protection for participants with multiple partners.