skip to main content

STI risk assessment before intrauterine contraception — DFSRH MCQ

Instant feedback + full explanation. One question, done properly.

EasyTestingSTI risk assessment before intrauterine contraceptionDFSRH

A 23-year-old nulliparous woman attends for planned insertion of a 52 mg levonorgestrel intrauterine device for contraception. Pregnancy has been reasonably excluded, and she is otherwise medically eligible. She began a new sexual relationship 2 months ago and reports inconsistent condom use. Neither partner is known to have a sexually transmitted infection. She has no abnormal vaginal discharge, pelvic pain, dyspareunia or postcoital bleeding. Abdominal and bimanual examinations are normal, with no cervical excitation or adnexal tenderness. She wishes to proceed with insertion today and can be contacted reliably when test results become available. Which is the most appropriate testing and insertion plan?

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

Reveal the answer and explanation

Correct answer: B — Obtain chlamydia and gonorrhoea NAATs; insert the device today without prophylactic antibiotics

Her new partnership and inconsistent condom use indicate increased STI risk, so chlamydia and gonorrhoea testing should be offered. However, risk factors alone do not constitute diagnosed infection. She is asymptomatic, has no examination findings suggesting cervicitis or pelvic inflammatory disease, and has no known exposure to an infected partner. FSRH guidance therefore supports obtaining NAAT samples at the insertion visit and proceeding without awaiting the results or giving routine prophylactic antibiotics, provided she can be contacted and treated promptly if a result is positive. A omits indicated risk-based screening, although immediate insertion without antibiotics is otherwise appropriate. B unnecessarily delays effective contraception: an asymptomatic person undergoing screening does not need a negative result before insertion. C adds prophylactic antibiotics despite the absence of a known infected partner, symptoms or another exceptional indication. D incorrectly treats STI risk as presumed infection and delays insertion without clinical evidence of infection. Deferral would instead be appropriate with current PID, purulent cervicitis, known gonorrhoea or symptomatic chlamydia until appropriate treatment and symptom resolution. E correctly integrates risk-based testing with same-day contraceptive provision. If either NAAT is subsequently positive, prompt management should be arranged in accordance with the relevant infection pathway.

Reference: FSRH Guideline: Intrauterine Contraception (March 2023, amended January 2025) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf