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PID with IUD in situ — DFSRH MCQ

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HardIntrauterine methodsPID with IUD in situDFSRH

Five days after copper-IUD insertion, a 26-year-old develops severe lower abdominal pain, fever, purulent cervical discharge and cervical-motion tenderness. Pregnancy test is negative; she is haemodynamically stable and ultrasound shows no tubo-ovarian abscess. What is the best initial management?

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Correct answer: D — Start PID antibiotics, retain the IUD and review at 72 hours

The best answer is “Start PID antibiotics, retain the IUD and review at 72 hours”. The syndrome warrants immediate empirical PID treatment; microbiology should be collected but treatment must not wait. An IUD can usually remain in situ initially, with clinical review at about 72 hours and consideration of removal if there is no improvement. Admission depends on severity, diagnostic uncertainty, pregnancy, abscess, inability to tolerate oral therapy or poor response, not simply the interval since insertion.

Reference: BASHH, UK national guideline for pelvic inflammatory disease: https://www.bashh.org/resources/6/guidelines_pid_2019/ | CoSRH/FSRH, Intrauterine Contraception (March 2023, amended January 2025): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf