Logo: to the web site of Uppsala University

The objectives of this case-control study, investigating 51 in-patient women with acute pelvic inflammatory disease (PID) and 50 healthy women attending for routine gynecological check-up, were to investigate the background and reproductive history of women, who are considered at low risk of sexually transmitted infection presenting with PID, to examine whether intrauterine device (IUD) use per se and long use affects the microbiology and clinical course of the disease, to identify risk factors for PID and to examine whether IUD use is an independent risk factor for PID.

The most striking difference regarding the background and reproductive history between women with PID and healthy women over age 25 were related to socio-demographic factors and not to common risk factors for PID.

There was little difference between healthy women and women with current PID with regard to single microbes. The finding of combinations of several anaerobic or aerobic/anaerobic microbes appeared to be associated with PID, particularly in women over 35. The pathogenesis of non-sexually transmitted PID appears to be associated with a synergistic effect between several pathogens, possibly facilitated by the presence of an IUD.

IUD use per se was associated with an increased risk of PID in women 35 and older. There was an association between IUD use and complicated PID in women over 35, which was possibly influenced by long-term IUD use. Age over 35 and IUD use, independently of each other, were associated with an increased risk of failed conservative treatment, necessitating surgery in patients with PID.

An observational study showed that Latvian obstetrician-gynecologists participate actively in contraceptive counseling and are very experienced with regard to IUD use. Physicians’ attitudes and perceptions towards IUD are generally positive and their clinical considerations are in good agreement with that of doctors in other countries. Antibiotics are widely used around IUD insertion by doctors, possibly driven by a liberal attitude towards IUD use in women with a potential risk of STI. The study could identify some possible gaps in the theoretical knowledge about the IUD and other methods.