What are the signs of an infection after IUD insertion?

Signs of Infection After IUD Insertion

The most important signs of infection after IUD insertion include fever, severe abdominal or pelvic pain, abnormal vaginal discharge, and unusual bleeding, which require prompt medical attention to prevent serious complications like pelvic inflammatory disease (PID). 1

Common Signs and Symptoms of Post-IUD Infection

Early Warning Signs (First 20 Days After Insertion)

• Fever (≥101°F [38.3°C] or >100.4°F [38.0°C] on multiple occasions)
• Severe or worsening lower abdominal/pelvic pain beyond expected post-insertion cramping
• Abnormal vaginal discharge (particularly if purulent or foul-smelling)
• Unusual vaginal bleeding (heavier than expected post-insertion bleeding)
• Pain during intercourse
• Uterine tenderness on examination

Critical Timing

The risk of pelvic inflammatory disease (PID) is highest in the first 20 days after IUD insertion 2. After this initial period, the additional risk of infection in IUD users, if it exists at all, is minimal.

Risk Factors for Post-IUD Infection

• Presence of sexually transmitted infections (STIs) at the time of insertion
• Insertion technique that doesn't maintain sterility
• Insertion immediately after septic abortion or during puerperal sepsis (both are contraindications) 1
• Bacterial contamination of the endometrial cavity during insertion 3

Specific Infections to Consider

Pelvic Inflammatory Disease (PID)

PID should be suspected when a patient presents with fever, abdominal pain, and uterine tenderness following IUD insertion 1. This is the most serious infection-related complication.

Actinomyces Infection

Actinomyces infections are uncommon but can occur in two scenarios:

• If a patient has an infection at the time of IUD insertion
• If the IUD is left in place past the recommended time of removal (typically 5 years) 1

Cervicitis

Purulent cervicitis is a contraindication to IUD insertion and may present with abnormal discharge and cervical inflammation 2.

Action Plan When Infection Is Suspected

1. Seek immediate medical attention if any signs of infection develop
2. Do not remove the IUD immediately in cases of PID - treatment can often be provided with the IUD in place 4
3. Complete the full course of antibiotics if prescribed

Prevention of Post-IUD Infection

• Pre-insertion screening for STIs in women at high risk 1, 2
• Proper insertion technique including cleansing the cervix with antiseptic solution 2
• Consistent condom use for women with IUDs who are at risk of STIs/HIV 2

Important Caveats

• Mild cramping and light spotting are normal after insertion and should not be confused with infection
• The copper IUD may cause heavier periods normally, which should not be confused with infection-related bleeding
• In rare cases, severe infections like streptococcal toxic shock syndrome can develop rapidly after IUD insertion and require emergency treatment 5
• Some pain and irregular bleeding may be associated with bacterial infection but don't always necessitate IUD removal if treated appropriately 6

Remember that while infections after IUD insertion are possible, they are relatively uncommon when proper insertion techniques are used and appropriate candidates are selected for IUD placement.