EFFECT OF IUD (INTRAUTERINE DEVICE) ON REPRODUCTIVE TRACT INFECTION (RTI) IN THE NORTHERN WEST BANK

Our study shows high prevalence rate of symptoms related to RTI  among women attending FP clinics. This finding was particularly high among the IUD users, either that related to alteration of vaginal discharge (86.6%), or symptoms related to RTI (91%), see tables 3, and 4. 

Studies in other parts of the world revealed similar association between vaginitis, and use of IUD. Sieber et al ⁷ and Amsel found a strong association of nonspecific vaginitis with the use of IUD ¹⁴. Some studies were done to explain this association between IUD use and vaginitis symptoms. Beerthuizen referred to the presence of IUD as a foreign body, which causes reaction to the host and response of endometrial tissue to the device similar to foreign body reaction ¹⁵. The change in the normal vaginal bacteria flora was another explanation. Egan reported that 40-50% percent of American women complains of vaginitis, and the most common bacterial organisms were Gardenella, Mycoplasma, and Streptococcus ⁹.

Table 3 shows a statistically significant relationship between vaginal discharge alteration and the presence of aerobic bacteria whether predominat or potentially pathogenic. In support of this relationship, Hawkes found in his study that endogenous infection (Candida, bacterial vagnosis) was diagnosed by laboratory in 32% of symptomatic women, method of contraception was the only significant factor with endogenous infection & 53% of which was among IUD users ¹³. Although there is significant association between IUD use and symptoms of vaginitis and RTI, different studies around the world 

point to the safety of IUD use and low rate of IUD discontinuation. The IUD continuation rate in a Libyan study was 96.1%, although increased nonspecific vaginitis (NSV) was one of the main medical complication in that study ¹⁶. An analysis of World Health Organization trials including over 22,000 women found that the primary risk of PID with IUD use occurs within the first 3 weeks after insertion; thereafter the risk declines to baseline levels and remains low ¹⁷.The effect of duration of IUD use on RTI related symptoms in our study showed an overall tendency to have milder symptoms   with longer IUD use (P=0.000).The findings in the first year of use were not statistically significant (P=0.572),in spite of having  higher rate of symptoms during that period .  

Although IUD has been related to RTI, a study in six countries including Egypt and Tunisia about contraceptive method discontinuation showed that IUD users were less likely than users of hormonal methods to stop because of health or side effects and were less likely to report method failure ¹⁸ .