Study Objective

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.

Design

Secondary analysis of a cluster-randomized provider educational trial.

Setting

Forty US-based reproductive health centers.

Participants

We followed 1350 participants for 12 months aged 18-25 years who sought contraceptive care.

Interventions

The parent study assessed the effect of provider training on evidence-based contraceptive counseling.

Main Outcome Measures

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.

Results

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).

Conclusion

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.

中文翻译：

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集群随机试验中老年青少年和年轻人的宫内节育器和性传播感染

学习目标

提供者对青少年和年轻女性宫内节育器 (IUD) 安全性的误解可能会不必要地限制所提供的避孕选择；我们试图评估采用宫内节育器的年轻女性的淋病奈瑟菌或沙眼衣原体(GC/CT) 诊断率。

设计

对集群随机提供者教育试验的二次分析。

环境

四十个美国生殖健康中心。

参与者

我们跟踪了 1350 名寻求避孕护理的 12 个月的 18-25 岁参与者。

干预措施

家长研究评估了提供者培训对循证避孕咨询的影响。

主要观察指标

我们使用 Cox 回归模型和广义估计方程根据宫内节育器的使用和性传播感染风险因素评估了 GC/CT 诊断的发生率。

结果

204 名参与者在基线时有 GC/CT 病史；在 12 个月的随访期内，103 人接受了新的 GC/CT 诊断。宫内节育器由 194 名参与者发起。使用 IUD 期间 GC/CT 诊断的发生率为每 100 人年 10.0 次，否则为 8.0 次。在调整后的模型中，宫内节育器的使用（调整后的风险比 [aHR]，1.31；95% 置信区间 [CI]，0.71-2.40），青少年年龄（aHR，1.28；95% CI，0.72-2.27），GC/CT 病史（aHR，1.23；95% CI，0.75-2.00）和干预状态（aHR，1.12；95% CI，0.74-1.71）与 GC/CT 诊断无关；然而，在基线报告有多个伴侣的个体中，新的 GC/CT 诊断率显着更高（aHR，2.0；95% CI，1.34-2.98）。

结论

在这个有 GC/CT 病史的年轻研究人群中，这种宫内节育器的使用是安全的，并且不会导致 GC/CT 诊断增加。然而，结果强调了双重性传播感染和怀孕保护对有多个伴侣的参与者的重要性。