From the Guidelines
No, you do not need to remove an IUD if a patient has a persistent chlamydia infection, as the recommended approach is to treat the infection while leaving the IUD in place, according to the most recent and highest quality study 1. The standard treatment for persistent chlamydia is doxycycline 100mg twice daily for 7-14 days, or azithromycin 1g as a single dose if compliance is a concern. If the infection persists after appropriate antibiotic therapy, consider testing for antibiotic resistance and potentially using alternative antibiotics such as moxifloxacin 400mg daily for 7-14 days. Some key points to consider in the management of IUDs in patients with chlamydia infection include:
- Treating the infection with appropriate antibiotics, as outlined in the CDC guidelines 1
- Ensuring that the patient's sexual partners are also treated to prevent reinfection
- Advising the patient to abstain from sexual activity until both they and their partners complete treatment
- Monitoring for complications such as pelvic inflammatory disease (PID) or tubo-ovarian abscess, which may require IUD removal
- Considering the risks and benefits of IUD removal, including the potential for unintended pregnancy if the IUD is removed and not replaced with another form of contraception, as discussed in the study 1. It's also important to note that IUDs do not increase the risk of PID or STIs beyond the first 21 days after insertion, and that treatment of STIs and PID can be provided without IUD removal, as supported by the evidence 1.
From the Research
Treatment of Chlamydia Infection
- The provided studies compare the efficacy of azithromycin and doxycycline for the treatment of urogenital and anorectal Chlamydia trachomatis infections 2, 3, 4, 5, 6.
- The studies suggest that doxycycline may be more effective than azithromycin for the treatment of anorectal Chlamydia trachomatis infections in both women and men who have sex with men (MSM) 4, 5, 6.
Removal of IUD
- There is no direct evidence in the provided studies regarding the removal of an intrauterine device (IUD) in patients with persistent Chlamydia infection.
- However, the studies focus on the treatment of Chlamydia infection, and the decision to remove an IUD would depend on various factors, including the patient's overall health, the type of IUD, and the severity of the infection.
Treatment Recommendations
- Based on the studies, doxycycline may be a more effective treatment option for anorectal Chlamydia trachomatis infections 4, 5, 6.
- Azithromycin may still be used as a treatment option, but its efficacy may be lower compared to doxycycline 2, 3.
- The treatment of Chlamydia infection should be guided by clinical guidelines and the patient's individual needs 2, 3, 4, 5, 6.