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Nairobi, Kenya, Ministry of Health, 2004 Jun.  p. (IUCD Method Briefs Update)The World Health Organization (WHO) recently revised the guidelines for IUCD use as part of an update of its Medical Eligibility Criteria for Contraceptive Use (MEC). These revisions will improve quality of care and reduce medical barriers for women who are considering an IUCD as a contraceptive method. Based on the latest clinical and epidemiological research, the revisions are particularly significant for women at risk of sexually transmitted infections (STIs), including HIV, and women living with HIV or AIDS. Research has shown that while some conditions restrict IUCD initiation, they do not necessarily affect the safety of continued use. Under the new guidelines, for example, a client who has gonorrhea or chlamydial infection is considered a Category 4 for IUCD initiation and should be advised to choose another method. However, if an IUCD user develops an STI, she can be treated with antibiotics without the IUCD being removed (Category 2). In addition, the client should be counseled about partner notification and treatment, and condom use. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 2-4. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The 2003 Expert Working Group made several changes to the MEC to indicate that women often can safely use IUDs in conditions related to HIV and other sexually transmitted infections (STIs). Taken together, these changes should help reduce some providers’ concerns about offering IUDs in areas where HIV infection and other STIs are common. At the meeting the WHO Expert Working Group concluded that a woman generally can start using an IUD, if she wishes, even if she has AIDS—provided she is receiving ARV therapy and is clinically well—or if she has HIV infection or she is at high risk of HIV infection. The Expert Working Group changed these conditions from category 3 to category 2 for starting IUD use. According to the bulk of research considered at the WHO meeting, IUD use does not increase a woman’s chances of acquiring HIV infection. Women generally can keep their IUDs if they become infected with HIV or develop AIDS while using IUDs (category 2), although IUD users with AIDS should be carefully monitored for pelvic infection. Limited evidence shows that complications of IUD use are no more common among IUD users infected with HIV than among IUD users who are not infected with HIV. Also, IUD use does not increase HIV transmission to sexual partners. (excerpt)
Lancet. 1992 Mar 28; 339(8796):783-4.It is difficult to determine if the IUD increases the risk of pelvic inflammatory disease (PID) because simple clinical features are not consistently predictive and can have low specificity and sensitivity. The C-reactive protein and the erythrocyte sedimentation rate tests help with PID diagnosis, but only a laparoscopy can determine tubal involvement. In 1970, WHO's Cooperative Statistical Programme found 2-year combined PID rates to range from 3.8 to 5.2/100 women with an IUD. Then WHO and various US organizations agreed IUD use did not necessarily cause PID. During the 1970s, however, a large rise in sexually transmitted diseases (STDs), especially chlamydia and gonorrhea, occurred and were associated with PID incidence. Many believed the growing rate of PID was attributable to the increasing use of IUDs. Many studies were biased because of overdiagnosis of PID. A 1990 review of 28 articles revealed that the overall PID rate was 1.49/100 woman years (lower than what many believed earlier). Some researchers used multicountry data on 22, 908 IUD insertions from WHO's data base for IUD studies to determine PID risk in IUD users. This risk was somewhat high during the 1st 20 days postinsertion which may be related to insertion, but PID rates in IUD users corresponded with those from the general population. PID rates did increase with age, however, and they did vary with geographical area. In addition, rates were 62% lower in women whose IUD was inserted after 1980. The PID rate was associated with background risk of STDs. These results and those of other studies suggest that health staff must adequately assess all patients before fitting the IUD and insert it only under strict aseptic conditions. IUDs that release copper and levonorgestrel pose a lower risk of PID than nonmedicated IUDs.