What is the protocol for the timing of insertion of an IUD after STI screening or treatment? #1010/14

Hi Dr. Hatcher! I hope you’re doing well! This is McLain (my husband and I worked on the Spanish Choices translation last year). I graduated from Emory, and I’ve been working as a CNM in Texas.


I’m happy to report that we are using a lot of LARC methods, and I’ve been able to place IUDs and recently started doing Nexplanons.


A question came up with a patient recently, and I was hoping that you would have some insight. A 33 year-old G3P2 was seen for vaginal discharge and treated for trich at the visit. GC/CT cultures were collected with a + chlamydia result. I just treated her and her partner yesterday. She is inconsistently using condoms, and she wants an IUD. I wasn’t sure if there is a protocol for the timing of insertion after sexually transmitted infection (STI) treatment. Do you have any advice? There was no consensus amongst my co-workers. She is open to Depo or oral contraceptive pills (OCPs) if needed.


Thank you so much and I hope you’re well!



Good morning, thanks for your note.  I am glad things are going well for you.



If treated for active PID, it is seriously recommended that IUD insertion be delayed until 3 weeks after treatment.


There is no consensus as to when to insert an IUD for a woman with a vaginal discharge that isn’t a florid discharge AND WHO DOES NOT HAVE PID.


So what is a florid discharge? It is a foul discharge, a profuse discharge, a nasty discharge or a “bad discharge.  Still not well defined is it?


But, Mallory, we do have a study of close to 57, 728 IUD insertions at Kaiser Permanente clinics in Northern California suggesting that what the clinician does for a woman (who does not have active pelvic inflammatory disease and does not have a florrd discharge) in terms of screening, timing of IUD insertion and  treatment makes no difference and is associated in all scenarios with a very low incidence of subsequent PID [Suffrin et al Obstet Gyneco l212]

If treated for active PID, it is generally recommended that IUD insertion be delayed until 3 weeks after treatment.



Below is a copy of an earlier question already posted on our website:


Question #701/14                          


Category:     Two questions about IUD insertions & screening for sexually transmitted infections


Trigger Question:     How many days after treating Chlamydia could I insert an IUD if she has no florid cervicitis or an active pelvic infection?


Q:        I have a patient who was just recently diagnosed with Chlamydia (CT) at her annual checkup and now wants a Mirena IUD.  How many days after treating Chlamydia would you safely insert an IUD?  I can’t find any literature on how long or if you should wait. Or if I could treat her and insert the IUD on the same day.


Jenny Stringer



She may receive an IUD immediately after treatment (i.e. the same day as she receives treatment. 


Below is a question which was posted on our website with much more information:


Does screening for STIs need to be done prior to IUD insertion if a woman has no symptoms of a florid vaginal discharge? #501-14


Q:        If I have a documented negative GC/CT (gonorrhea/Chlamydia test) from the initial prenatal visit, should I be repeating screening at the time of a postpartum IUD insertion?


A:        Short answer:


An IUD may be inserted at the time of the postpartum visit if the woman does not have a clinically diagnosed pelvic infection or a florid vaginal discharge.


Long answer:

A Kaiser Permanente study in Northern California of 57,728 IUD insertions found a 0.54% (1 in 2,000) rate of infection in the 90 days post IUD insertion.  There was not a difference in the risk of infection:

  • If there was no screening for Chlamydia and gonorrhea on the day of insertion or in the year before insertion (47.1% of insertions).
  • Women were screened on the day of insertion (9.8% of insertion).
  • Screening was done 1-8 weeks before insertion (19.1% of insertions).
  • Screening was done 8 weeks to 1 year before insertion (23.7% of insertions).


The risk of pelvic infection is low whether or not a woman is screened for Chlamydia and gonorrhea before, on the day of IUD insertion, or is not screened at all. [CB Suffrin et al Obstet Gynec 2012]



To learn more about the advantages and disadvantages of IUDs, Depo-Provera and birth control pills; go to: www.managingcontraception.com  You can order these educational book from our website or by calling 404-875-5001.     


Key Words:  LARC methods, IUD, placement, Nexplanon implants, vaginal discharge, trich, cultures, Chlamydia, condoms, IUD, protocol, insertion, Depo-Provera, birth control pills, florid discharge, profuse, Kaiser Permanente clinics, study, PID


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Choices 2014 Edition


Posted on

November 17, 2014