Chlamydia screening before IUD insertion [letter]

A recommendation for routine chlamydia screening at the time of IUD insertion has many rationales. The risk of pelvic inflammatory disease (PID) etiologically linked to chlamydia is greatest in the first 20 days after IUD insertion due to insertion-related transient microbiological contamination of the uterine cavity. Moreover a significant reduction in PID has been recorded in IUD acceptors who were screened for PID and if positive treated with 100 mg doxycycline for 2 weeks compared to unscreened and untreated controls. A reduction in subsequent PID rates may also occur. In addition chlamydia screening has been effective in reducing subsequent PID in women undergoing pregnancy termination. Chlamydia screening is considered cost-effective in situations where the prevalence rate is 6% or above; family planning clinics have reported chlamydia rates in the range of 4.9-7.3%. The major obstacle to acceptance of such a regimen is the failure of any randomized controlled trial to document its effectiveness. This failure may reflect the inadequacy of the antibiotic dose (stat dose of 200 mg of doxycycline) used in most clinical trials. Treatment with a 7-day course of doxycycline might produce more positive results.