a) Yes, if the woman has no current risk factors for STDs (by history and on exam) and she has no apparent clinical signs or symptoms of infection (including normal bimanual exam).
b) If PID, mucopurulent endocervical discharge, cervicitis or clinically apparent vaginitis is present, do not insert IUD, but treat for infection. Consider other contraceptive methods, if an STD* is suspected.
* NOTE: Not all clinically-apparent vaginal infections are due to STDs.
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a-b) Currently available lab tests may be impractical and often unaffordable (even in the developed world) to rule out endocervical colonization by infectious agents capable of ascending and causing PID. Most chlamydia tests are only 80 to 90% sensitive, tests for mycoplasma and ureaplasma are not routinely available, and cervical gram stain is less sensitive for gonorrhea. However, where gonorrhea culture and chlamydia tests are affordable, negative test results provide reassurance to corroborate the woman's history.
- Kramer D, Brown S. Sexually transmitted diseases and infertility. International Journal of Gynaecology and Obstetrics 1984;22:19-27.
- Bell TA, Grayston JT. Centers for Disease Control guidelines for prevention and control of Chlamydia trachomatis infections. Annals of Internal Medicine 1986;104:524-526.
- Nasello M, Callihan D, Menpus M, Steighigel R. A solid-phase enzyme immunoassay (gonozzyme®) test for direct detection of Neisseria gonorrhoeae antigen in urogenital specimens from patients at a sexually transmitted disease clinic. Sexually Transmitted Diseases 1985;(October-December):198-202.
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