Rate Of Pelvic Inflammatory Disease Research Articles

Chlamydial and Gonococcal Infections and Adverse Reproductive Health Conditions Among Patients Assigned Female at Birth in the Veterans Health Administration.

Reproductive age female individuals comprise the fastest-growing segment of Veterans Health Administration patients, but little is known about rates of reproductive health outcomes among those with chlamydia or gonorrhea infections. Our aim was to estimate the risk of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain in female veterans tested for chlamydia or gonorrhea. We performed a retrospective cohort analysis of female veterans tested for chlamydia or gonorrhea between January 1, 2010, and December 31, 2020. We calculated rates of pelvic inflammatory disease, ectopic pregnancy, infertility, and pelvic pain per 100,000 person-years and used Cox proportional hazards regression models to estimate the risk of these reproductive health conditions according to infection status after adjustment for age, race, ethnicity, military sexual trauma, mental health diagnoses, and substance use disorder. Of female veterans, 232,614 were tested at least once for chlamydia or gonorrhea, with a total of 1,665,786 person-years of follow-up. Of these, 12,971 had positive chlamydia or gonorrhea results (5.8%, 796 cases per 100,000 person-years). Compared with people who tested negative, those testing positive had double the risk of pelvic inflammatory disease (adjusted hazard ratio [aHR], 1.94; 95% confidence interval [CI], 1.81-2.07), 11% increased risk of infertility (aHR, 1.11; 95% CI, 1.04-1.18), 12% increased risk of pelvic pain (aHR, 1.12; 95% CI, 1.08-1.17), and 21% increased risk of any of these conditions (aHR, 1.21; 95% CI, 1.17-1.25). People with positive chlamydia or gonorrhea testing tended to have an increased risk of ectopic pregnancy (aHR, 1.14; 95% CI, 1.0-1.30). Among those with a positive test result, 2218 people (17.1%) had 1 or more additional positive test results. Compared with those with 1 positive test result, people with more than 1 positive test result had a significantly increased risk of pelvic inflammatory disease (aHR, 1.37; 95% CI, 1.18-1.58), infertility (aHR, 1.20; 95% CI, 1.04-1.39), and pelvic pain (aHR1.16; 95% CI, 1.05-1.28), but not ectopic pregnancy (aHR, 1.09; 95% CI, 0.80-1.47). Female veterans with positive chlamydia or gonorrhea results experience a significantly higher risk of pelvic inflammatory disease, infertility, and pelvic pain, especially among those with repeat infection.

Epidemiological and Clinical Characteristics of Women Living with HIV in Korea.

While Korea maintains a low prevalence of human immunodeficiency virus (HIV), the number of newly diagnosed cases has been steadily rising, reaching approximately 1,000 annually in recent years. The 2022 annual report from the Korea Disease Control and Prevention Agency revealed that women living with HIV (WLWH) constitute 6.4% of the total confirmed people living with the HIV population, totaling 1,219 individuals. Despite this, only a few studies have focused on WLWH in Korea. This study aims to analyze the epidemiological and clinical characteristics of WLWH in Korea. We retrospectively collected data by reviewing the medical records of all WLWH who visited 10 urban referral hospitals across Korea between January 2005 and May 2023. A total of 443 WLWH were enrolled in this study. The predominant risk exposure was heterosexual contact, with 235 (53%) participants either married or cohabiting with a male partner at their initial clinic visit. Among the participants, 334 (77.7%) were Korean, 27 (6.1%) were Southeast Asian, and 19 (4.3%) were African. Antiretroviral therapy was initiated by 404 WLWH (91.2%). We observed 118 pregnancies in WLWH following their HIV diagnosis, resulting in 78 live births (66.1%), 18 induced abortions (15.2%), 10 pre-viable fetal losses (8.5%), and four stillbirths (3.4%). Over a cumulative follow-up duration of 3,202.1 years, the incidence rates of breast and cervical cancers were both 2.18 per 1,000 person-years. Additionally, the incidence rates of pelvic inflammatory disease, cervical intraepithelial neoplasm (above grade II), and osteoporosis were 4.67, 11.21, and 13.39 per 1,000 patient-years, respectively. This is the first multicenter study to investigate the clinical and epidemiological characteristics of WLWH in Korea. The incidence and prevalence of diseases in women, including breast cancer, cervical cancer, and chronic comorbidities, are high in WLWH in Korea; therefore, further research and efforts are needed to manage these diseases.

Spherical Ball-Shaped Intrauterine Device Long-Acting Reversible Contraception: Post-marketing Pharmacovigilance Assessment

Objective: Pharmacovigilance assessment of a novel intrauterine spherical ball-shaped copper intrauterine device (Spherical Copper 300 mm2 intrauterine device [IUD]; OCON Medical Ltd., Modiin, Israel]) using data collected from both users and healthcare providers. Study Design: Pharmacovigilance reports of undesirable side effects (events) were collected and evaluated based on healthcare providers who completed pharmacovigilance reporting related to device insertion and outcomes. Results: Data was reviewed from 111,022 insertions from 23 countries. Insertions were performed by multiple types of providers: nurse practitioners, midwives, general practitioners, and obstetrician-gynaecologists. Out of 111,022 insertions, a total of 496 accumulative pregnancies were reported over a period of 70 months, for an effectiveness of 99.6% (n=110,706) over the reported period. Few complications were reported. Of those reported, expulsion rate was 3.30% (n=3,619), with median time from insertion to expulsion of 7 weeks (0–60 weeks), perforation rate of 0.05% (n=60), and pelvic inflammatory disease rate of 0.02% (n=23). Conclusions: The Spherical Copper 300 mm2 IUD was used in a diverse group of women by a variety of medical providers. Spherical Copper 300 mm2 IUD use suggests high efficacy and safety with infrequent complications. The Spherical Copper 300 mm2 IUD is an additional option for women desiring reliable, reversible, long-acting, and non-hormonal contraception. Implications: Females interested in a safe and highly effective, long-acting, reversible contraceptive method would benefit from additional options. Currently, the T-shaped Copper 380 mm2 IUD is the most prevalent, non-hormonal, long-acting, reversible contraceptive method for females, with over 99% effectiveness. The Spherical Copper 300 mm2 IUD offers an alternative contraceptive option for females who do not desire exogenous oestrogen or progestin exposure.

Effect of Dhanwantharam Taila Uttaravasthi and Guggulupanchapala Choorna in Bilateral Tubal Block: A Case Study

The prevalence of tubal factor infertility is higher in India due to higher rates of unrecognized PID (pelvic Inflammatory Disease). The risk of PID leading to scarring, adhesions, and partial or total obstruction of fallopian tubes necessities an aggressive approach to managing PID. PID has features similar to Yoniroga paripluta caused by Vata pitta dusti. In this case study, the patient experienced thick yellowish-white mucoid vaginal discharge while also suffering from recurrent UTIs for six months. She was diagnosed with bilateral tubal block and had a one-year history of infertility. The line of treatment was to normalize Vata-pitta dosha, as Paripluta was the root cause of tubal blockage here. Here the aim was to alleviate vitiated Vata pitta dosha and achieve Artava vaha sroto sodhana. Srotorodha in the Artava vaha srotas were eliminated by proper Sodhana, Shamana, and Sthanika chikitsa. Uttara vasthi effectively removes tubal block as it can deliver medicines close to the fallopian tube. Uttara vasthi with Dhanwantharam tailam can relieve abnormalities of the fallopian tube generated by Rooksha, Daruna, and Khara guna of Vata. All this management not only helps to get tube patency but also restores its normal physiological function. After receiving treatment for six months, the patient came with a normal Hysterosalpingography (HSG) report and reported symptomatic improvement.

Management of Chlamydia Cases in Australia (MoCCA): protocol for a non-randomised implementation and feasibility trial

IntroductionThe sexually transmitted infection chlamydia can cause significant complications, particularly among people with female reproductive organs. Optimal management includes timely and appropriate treatment, notifying and treating sexual partners, timely retesting...

Successful Provision of Long-Acting Reversible Contraception in a Sexual Health Clinic.

Women who attend sexual health clinics are at high risk for sexually transmitted infections and unintended pregnancy. Long-acting reversible contraceptives (LARC) are very effective contraceptive methods, but the provision of LARC in such clinics is not well described in the literature. We conducted a retrospective chart review of women who presented to Denver Sexual Health Clinic for any reason and received family planning services between April 1, 2016, and October 31, 2018. We assessed demographic and clinical factors associated with contraceptive method received and conducted a subanalysis of those with intrauterine device (IUD) insertions on the same-day versus delayed insertion. Among those who received an IUD, we assessed rates of pelvic inflammatory disease (PID) 30 days after insertion. Of the 5064 women who received family planning services in our clinic, 1167 (23%) were using a LARC method at the time of their visit. Of the 3897 who were not using a LARC, fewer women, 12.6%, chose LARC (IUD and progestin implant), compared with 33.3% who chose new short-acting reversible contraceptives. Further analysis of the 270 IUD initiators revealed 202 (74.8%) received the IUD on the same day, whereas 68 (25.2%) had delayed IUD insertion. There were 9 incident cases of gonorrhea or chlamydia in those who received same-day IUD and 1 incident case among those who had delayed IUD insertion. There were no cases of PID at 30 days after insertion in either group. Study findings support IUD provision in a sexual health clinic on the day of initial visit without increased risk of PID.

Tubal factor infertility and its impact on reproductive freedom of African American women

In the past, the reproductive freedom of African American women was hindered by forced reproduction and sterilization campaigns. Unfortunately, these involuntary practices have now mostly been replaced by inequality because of disproportionate tubal factor infertility rates within African American communities. Our work aimed to describe the inequities in increased rates of pelvic inflammatory disease and tubal factor infertility as it relates to African American women. In addition, we highlighted the need for improved access to screening and treatment of sexually transmitted infections, access to barrier contraception, and health literacy related to the understanding and prevention of tubal factor infertility in African American women.

Antibiotic therapy for pelvic inflammatory disease

Antibiotic therapy for pelvic inflammatory disease

Relation between Chlamydia trachomatis infection and pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility in a Dutch cohort of women previously tested for chlamydia in a chlamydia screening trial

ObjectivesA better understanding of Chlamydia trachomatis infection (chlamydia)–related sequelae can provide a framework for effective chlamydia control strategies. The objective of this study was to estimate risks and risk factors...

Trends in diagnosis of pelvic inflammatory disease in an Australian sexual health clinic, 2002-16: before and after clinical audit feedback.

Yearly PID diagnosis rates for women aged 16-49 years attending the clinic (2002-16) were calculated. Using multivariable generalised linear mixed models, adjusted for patient risk and lower genital infection (any of chlamydia, gonorrhoea, Mycoplasma genitalium, bacterial vaginosis) and stratified by before (2002-June 2007) and after (July 2007-2016) feedback, we assessed if PID rates changed over time, accounting for between-doctor variability. During 2002-16, 144 doctors undertook 84476 female consultations and diagnosed 1755 (2.1%, 95% confidence interval (CI) 2.0-2.2) with PID. Comparing 2002-03 to 2015-16, the yearly PID rate increased; 0.8% (37/4836) to 2.9% (209/7088). Comparing before and after feedback more women reported any symptoms at triage (35.1%-47.2%) or had a lower genital infection diagnosed (10.1%-14.9%). After feedback, PID rates increased by 8% yearly (incidence rate ratio (IRR) 1.08, 95% CI 1.06-1.11), but were unchanged (adjusted IRR (aIRR) 1.01, 95% CI 0.98-1.03) after adjustment for patient characteristics. Factors associated with PID were self-reported symptoms, younger age and a lower genital infection. Lower variability in doctor-specific rates was observed after feedback. Increasing PID diagnosis rates appeared to be driven by a greater female patient risk profile, influenced by increased capacity following service improvements.

Repeat Chlamydia Diagnoses Increase the Hazard of Pelvic Inflammatory Disease among US Army Women: A Retrospective Cohort Analysis.

In the US military, chlamydia is the mostly commonly diagnosed bacterial sexually transmitted infection and the rates of pelvic inflammatory disease (PID) have remained high since the early 2000s. The relationship between the number of chlamydia diagnoses and hazard of PID was investigated in a retrospective cohort analysis among US Army women from 2006 to 2012. Cox regression model was used to estimate hazard ratios for associations between the number of repeat chlamydia diagnoses and PID. The study population comprised 33,176 women with chlamydia diagnosis. Of these, 25,098 (75%) were diagnosed only once ("nonrepeaters"). By comparison, 6282 (19%), 1435 (4%), and 361 (1%) women had one, two and three repeat chlamydia diagnoses, respectively. Among these 4 groups, 1111, 325, 72, and 25 PID diagnoses were noted. According to the Cox regression analysis, for every additional diagnosis of chlamydia, the hazard of PID increased by 28% (95% confidence interval, 19%-38%) compared with women with a single diagnosis or nonrepeaters. Moreover, the corresponding adjusted hazard ratio of 1.28, 1.35, and 1.97 represented a significantly greater risk for PID among the three "repeater" groups compared with nonrepeaters. We found an increased hazard of PID among US Army women with repeat chlamydia diagnoses and the characterization of a dose-response relationship. These findings reinforce the notion that early diagnosis and treatment of chlamydia is necessary to avoid subsequent PID and associated morbidity.

Trends in Pelvic Inflammatory Disease Among American Indian and Alaska Native Women, Indian Health Service, 2001-2015.

To describe trends in rates of pelvic inflammatory disease (PID) encounters among American Indian/Alaska Native (AI/AN) women aged 15 to 44 years in the United States receiving care within the Indian Health Service (IHS). We analyzed IHS discharge data sets for PID encounters during 2001 to 2015 with International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes. We calculated rates of PID encounters per 100 000 women overall and stratified by age group, region, and health care setting. We used regression to identify trends in the total, annual, and average annual percent changes in the rate of PID encounters. There were 44 042 PID encounters during 2001 to 2015 (rate = 825 per 100 000). The highest rates were among women aged 20 to 24 years (1104) and from the Alaska region (1556). Rates significantly decreased overall (2001: 1084; 2015: 512; P < .001) and within all age groups and health care settings. There was variability in Alaska, with large increases during 2001 to 2010 followed by large decreases during 2010 to 2015. We observed decreasing trends in PID encounters among AI/AN women aged 15 to 44 years during 2001 to 2015, with the exception of increases in the Alaska region.

Rates of pelvic inflammatory disease and ectopic pregnancy in Australia, 2009–2014: ecological analysis of hospital data

ObjectiveTo analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014.MethodsWe calculated yearly PID and EP diagnosis rates...

Discovery of Blood Transcriptional Endotypes in Women with Pelvic Inflammatory Disease.

Sexually transmitted infections with Chlamydia trachomatis and/or Neisseria gonorrhoeae and rates of pelvic inflammatory disease (PID) in women continue to rise, with reinfection being common because of poor adaptive immunity. Diagnosis remains imprecise, and pathogenesis data are derived primarily from monoinfection of mice with C. trachomatis or N. gonorrhoeae By comparing blood mRNA responses of women with C. trachomatis- and/or N. gonorrhoeae-induced PID and histologic endometritis with those from women with C. trachomatis and/or N. gonorrhoeae infection limited to their cervix and asymptomatic uninfected women determined via microarray, we discovered important pathogenic mechanisms in PID and response differences that provide a pathway to biomarker discovery. Women with N. gonorrhoeae- and/or C. trachomatis-induced PID exhibit overexpression of myeloid cell genes and suppression of protein synthesis, mitochondrial oxidative phosphorylation, and T cell-specific genes. Coinfected women exhibited the greatest activation of cell death pathways and suppression of responses essential for adaptive immunity. Women solely infected with C. trachomatis expressed elevated levels of type I and type II IFN genes, and enhanced type I IFN-induced chemokines in cervical secretions were associated with ascension of C. trachomatis to the endometrium. Blood microarrays reveal discrete pathobiological endotypes in women with PID that are driven by pathogen invasion of the upper genital tract.

Risk of pelvic inflammatory disease after intrauterine insemination: a systematic review.

The aim of this study was to ascertain the incidence of pelvic inflammatory disease (PID) after intrauterine insemination (IUI). A systematic review was conducted using three different approaches: a search of IUI registries; a search of published meta-analyses; and a search of prospective randomized trials. Search terms were 'IUI', 'complications', 'infection' and 'PID'. Two IUI registers were identified that met the inclusion criteria, totalling 365,874 cycles, with 57 PID cases being reported. The post-IUI PID rate was 0.16/1000 (95% CI 0.2 to 0.3/1000). The frequency was higher in husband sperm cycles (0.21/1000) (28/135,839) than in donor sperm cycles (0.03/1000) (1/33,712) (P < 0.05; OR 6.95). Nineteen meta-analyses were retrieved, which included 156 trials, totalling 43,048 cycles, with no PID case being reported. Seventeen prospective clinical trials published between 2013 and 2014 were identified, totalling 4968 cycles; no PID case was reported. The reported rate of post-IUI clinical PID is low (0.16/1000), about 40% higher than reported in the general population of women during their reproductive life. No antibiotic prophylaxis should be recommended unless there is an associated risk factor.

Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study.

There is uncertainty around whether the risks of pelvic inflammatory disease (PID) differ following Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) infection. We quantified the risk of PID associated with chlamydia and gonorrhea infection and subsequent repeat infections in a whole-population cohort. A cohort of 315123 Western Australian women, born during 1974-1995, was probabilistically linked to chlamydia and gonorrhea testing records and to hospitalizations and emergency department presentations for PID from 2002 to 2013. Time-updated survival analysis was used to investigate the association between chlamydia and gonorrhea testing, and positivity, and risk of PID. Over 3199135 person-years, 120748 women had pathology test records for both chlamydia and gonorrhea, 10745 chlamydia only, and 653 gonorrhea only. Among those tested, 16778 (12.8%) had ≥1 positive chlamydia test, 3195 (2.6%) ≥1 positive gonorrhea test, and 1874 (1.6%) were positive for both. There were 4819 PID presentations (2222 hospitalizations, 2597 emergency presentations). Adjusting for age, Aboriginality, year of follow-up, health area, and socioeconomic status, compared to women negative for chlamydia and gonorrhea, the relative risk (adjusted incidence rate ratio) of PID was 4.29 (95% confidence interval [CI], 3.66-5.03) in women who were both chlamydia and gonorrhea positive; 4.54 (95% CI, 3.87-5.33) in those only gonorrhea positive; and 1.77 (95% CI, 1.61-1.94) in those only chlamydia positive. Gonorrhea infection conferred a substantially higher risk than chlamydia of hospitalization or emergency department presentation for PID. The emergence of gonorrhea antimicrobial resistance may have a serious impact on rates of PID and its associated reproductive health sequelae.

Sexually Transmitted Infections, Pelvic Inflammatory Disease, and the Role from Intrauterine Devices: Myth or Fact?

Connections among Intra Uterine Devices (IUD), Sexually Transmitted Diseases (STDs) and Pelvic inflammatory disease (PID) still bring doubts for health professionals; Our goal is to understand better these associations. We searched the PubMed database for articles including evidence about these topics. A common outcome found is the superiority of levonorgestrel (LNG) IUD over NOVA T (copper) device regarding clinical performance and PID rates. The modern IUDs do not elevate the risk of getting PID; however this risk is higher when a patient has a STI at the time she gets an IUD. It is wise requiring a STI test, principally for cervicitis, before placing an IUD. The epidemiologic data suggests this management mainly for woman with a new sexual partner, or with multiple sexual partners, and under age 25. It is also correct inserting an IUD and test for STI at the same day: if positive results come, antibiotics can be used. Old papers usually show a higher risk for PID in IUD users, an outcome not found in recent researches that have improved methodology and therefore are more reliable. However, the investigation concerning the STI and cervicitis remain as an important point to investigate before decision to IUD use.

Pelvic inflammatory disease: improving awareness, prevention, and treatment.

PurposePelvic inflammatory disease (PID) is a common disorder of the reproductive tract that is frequently misdiagnosed and inadequately treated. PID and its complications, such as infertility, ectopic pregnancy, and chronic pelvic pain, are preventable by screening asymptomatic patients for sexually transmitted infections (STIs) and promptly treating individuals with STIs and PID.Recent findingsThe rates of adverse outcomes in women with PID are high and disproportionately affect young minority women. There are key opportunities for prevention including improving provider adherence with national screening guidelines for STIs and PID treatment recommendations and patient medication adherence. Nearly half of all eligible women are not screened for STIs according to national quality standards, which may increase the risk of both acute and subclinical PID. Moreover, in clinical practice, providers poorly adhere to the Centers for Disease Control and Prevention recommendations for treatment of PID. Additionally, patients with PID struggle to adhere to the current management strategies in the outpatient setting.ConclusionNovel evidence-based clinical and public health interventions to further reduce the rates of PID and to improve outcomes for affected women are warranted. We propose potential cost-effective approaches that could be employed in real-world settings.

P08.18 Regional variation in emergency department presentation rates of chlamydia related morbidity in four states of australia

Background Pelvic inflammatory disease (PID) and ectopic pregnancy among women and epididymitis among men are important sequelae of chlamydia. In Australia, chlamydia prevalence is higher among younger populations, Indigenous Australians, and in regional and remote areas. The burden of chlamydia sequelae by Australian region is unknown. We assessed if rates of emergency department (ED) presentations in Australia for chlamydia sequelae vary by remoteness of residence. Methods Age and sex specific ED rates per 100,000 population of PID, ectopic pregnancy or epididymitis among 15–44 year-old Victorian, New South Wales, Queensland and South Australian residents were calculated for the years 2009 and 2010 using hospital and Australian Bureau of Statistics estimated resident population data. Logistic regression was used to assess regional variation in rates and adjusted for age, remoteness and socio-economic group (SES) of residential postcode in deciles. Results During 2009–2010, overall ED rates per 100,000 among 15–44 year-old residents from all four states were 76.8 (95% CI: 74.8–78.8) for PID, 73.0 (95% CI: 71.1–75.0) for ectopic pregnancy and 86.4 (95% CI: 84.3–88.4) for epididymitis. Multivariable analysis showed that PID rates in female residents: were higher in inner-regional (AOR = 1.6; 95% CI: 1.5–1.7) and outer regional/remote areas (AOR = 2.1; 95% CI: 1.9–2.3) compared with metropolitan areas; increased by 6%(95% CI: 5%–7%) per decile of increasing disadvantage of postcode; and were higher in women aged 15–24 (AOR = 2.4,95% CI: 2.3–2.6) and 25–34 years (AOR = 1.7; 95% CI: 1.6–1.8) compared with 35–45 years. Ectopic pregnancy rates in females were higher in inner-regional (AOR = 1.3; 95% CI: 1.2–1.4) and outer regional/remote (AOR = 1.7; 95% CI: 1.5–1.8) areas; increased by 6% (95% CI: 5%–7%) per decile of increasing disadvantage; and were highest among 25–34 year-old women (AOR: 2.1; 95% CI: 2.0–2.3). In men, epididymitis rates were higher in inner-regional (AOR = 1.6; 95% CI: 1.5–1.7) and outer regional/remote (AOR = 2.3; 95% CI: 2.2–2.5) areas and did not differ by age or SES. Conclusion Possible explanations for higher ED rates of chlamydia sequelae in non-metropolitan Australian residents could be higher chlamydia prevalence or variable access to primary healthcare in these areas. Disclosure of interest statement These data are being analysed as part of the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) study funded by the Commonwealth Department of Health and the National Health and Medical Research Council.

Positive Testing for Neisseria gonorrhoeae and Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease in IUD Users.

Unintended pregnancies are a major public health problem in the United States, and intrauterine devices (IUDs) are among the most effective reversible birth control methods available. Historically, there have been concerns about IUD use and infection among young and/or high-risk women that may increase the risk of pelvic inflammatory disease (PID) and subsequent infertility. The Contraceptive CHOICE Project (CHOICE) was a prospective cohort study of over 9,000 women 14-45 years of age residing in the St. Louis area who were interested in initiating a new form of reversible contraception. At enrollment, participants were counseled regarding long-acting contraceptive methods with the goal of increasing awareness of all reversible methods available. Participants were also tested for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) during enrollment and were provided with contraception at no cost for 2-3 years. We estimate the frequency of self-reported PID in new IUD users compared with women using other contraceptive methods. Among both new IUD users who tested positive for GC and/or CT and those who tested negative, the PID rate was 1% or below. Our results demonstrate that IUD use is safe for all women, including women at high risk for sexually transmitted infections.