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Asymptomatic chlamydia before intrauterine contraception insertion — DFSRH MCQ

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EasyRisk AssessmentAsymptomatic chlamydia before intrauterine contraception insertionDFSRH

A 29-year-old woman attends for planned insertion of a 52 mg levonorgestrel intrauterine device. Her etonogestrel implant remains within its recommended duration of use for another 9 months. She has not had unprotected sexual intercourse requiring emergency contraception. A vulvovaginal NAAT taken at a sexual health clinic 3 days ago is positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae. She has not yet started treatment. She reports no pelvic pain, dyspareunia, abnormal bleeding or vaginal discharge. Examination shows no purulent cervicitis, cervical excitation, uterine tenderness or adnexal tenderness. Which is the most appropriate approach to the planned intrauterine contraception insertion?

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

Reveal the answer and explanation

Correct answer: B — Complete chlamydia treatment and insert once asymptomatic without prophylactic antibiotics

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

She has confirmed, currently untreated asymptomatic chlamydia. Initiation of intrauterine contraception in this setting is UKMEC3: the risks generally outweigh the benefits. Same-day insertion may be considered when an emergency IUD is required, provided chlamydia treatment is commenced, but she has effective ongoing contraception and no emergency indication. Insertion should therefore be deferred while her implant continues to provide contraception. FSRH advises that following a positive chlamydia result, intrauterine contraception may be inserted after antibiotic treatment has been completed and the individual is asymptomatic. Routine prophylactic antibiotics are not required. A imposes a negative repeat NAAT as a routine prerequisite, whereas FSRH specifies completion of treatment and absence of symptoms, with additional follow-up only when otherwise indicated. B resembles the exception for an emergency IUD but is inappropriate for an elective insertion with effective contraception already in place. C is premature because 48 hours does not establish completion of the prescribed treatment. D uses the correct post-treatment timing but adds unnecessary antibiotic prophylaxis. E appropriately integrates the confirmed infection, absence of pelvic inflammatory disease, lack of emergency need and availability of effective interim contraception.

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 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 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