Intrauterine Devices and Sexually Transmitted Infection among Older Adolescents and Young Adults in a Cluster Randomized Trial

Alison M. El Ayadi*, Corinne H. Rocca, Sarah H. Averbach, Suzan Goodman, Philip D. Darney, Ashlesha Patel, Cynthia C. Harper

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
JournalJournal of pediatric and adolescent gynecology
StateAccepted/In press - 2021


  • Adolescent
  • Chlamydia trachomatis
  • Contraception
  • Intrauterine device
  • Neisseria gonorrhoeae
  • Sexually transmitted diseases

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health


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