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Chlamydial cervicitis in an established LNG-IUD user — DFSRH MCQ

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EasyCervicitisChlamydial cervicitis in an established LNG-IUD userDFSRH

A 27-year-old woman has used a 52 mg levonorgestrel intrauterine device for 18 months. She presents with postcoital bleeding after starting a new sexual relationship. Speculum examination shows mucopurulent endocervical discharge and easily induced cervical bleeding. A vulvovaginal NAAT is positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae. Her pregnancy test is negative. She has no fever or pelvic pain, and there is no cervical excitation, uterine tenderness or adnexal tenderness. She wishes to continue using intrauterine contraception. What is the most appropriate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Commence chlamydia management and retain the LNG-IUD in situ

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

This is uncomplicated chlamydial cervicitis: mucopurulent discharge, contact bleeding and a positive chlamydia NAAT are present, but there are no clinical features of upper genital tract infection. FSRH distinguishes initiation from continuation of intrauterine contraception. Symptomatic chlamydia and purulent cervicitis are UKMEC4 for IUC initiation, but UKMEC2 for continuation. The established LNG-IUD can therefore remain in situ while chlamydia treatment, partner notification and appropriate sexual-health advice are arranged. B incorrectly applies the contraindication to insertion as if it mandated removal of an existing device. C imports the 48–72-hour review threshold used for pelvic inflammatory disease: IUC removal is usually considered when PID fails to improve after antibiotics, not merely because cervical discharge persists during early treatment. D is inappropriate because compatible cervicitis and a positive NAAT provide sufficient evidence to treat; delay risks ongoing transmission and ascending infection. E requires a new intrauterine insertion, which is contraindicated while symptomatic chlamydia or purulent cervicitis is present. A copper IUD could be considered later, after treatment and symptom resolution, if the patient independently wished to change methods.

Reference: FSRH Guideline: Intrauterine Contraception (March 2023; amended 21 January 2025) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf FSRH Guideline: Intrauterine Contraception, section 14.4.1 (March 2023; amended 21 January 2025) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf Chlamydia (Reviewed 24 October 2024) — https://www.nhs.uk/conditions/chlamydia/