Screening for Bacterial Vaginosis at the Time of Intrauterine Contraceptive Device Insertion: Is There a Role?

Objective: To estimate the prevalence of bacterial vaginosis (BV) among women attending outpatient gynaecology clinics for insertion of an intrauterine contraceptive device (IUD); and to describe any differences between BV-positive and BV-negative women at one month after insertion with respect to four primary clinical outcomes: expulsion of IUD, pain, fever > 38 degrees C, and heavy bleeding. Methods: We carried out an observational prevalence study between March 2008 and March 2009. Seventy women were each followed for one month. Vaginal cultures for BV were obtained before and at one month after IUD insertion, and women were assessed for complications at one month after insertion. Thirty-eight women had a copper IUD (Cu-IUD) inserted and 32 had a levonorgestrel-releasing IUD (LNG-IUD) inserted. Bacterial vaginosis was diagnosed using Nugent's scoring and Gram stain evaluation of the cultures. Frequency distributions, Student t test, and Fisher exact test of independence were used to analyze the data. Results: The prevalence of BV was 7.1%. Five women were found to be BV positive at the time of IUD insertion, and none experienced any clinical complications. One BV-negative patient developed a tubo-ovarian abscess three months after LNG-IUD insertion, and another BV-negative patient reported persistent, thick vaginal discharge after Cu-IUD insertion. Of 43 BV-negative patients who had repeat cultures performed at their one-month follow-up visit, four (9.3%) shifted from having normal flora to being BV positive. We found no significant relationship between a patient's BV status and any clinical outcome. Conclusion: The incidence of BV in this study was lower than that described in other populations. No clinical complications occurred among the BV-positive women. Screening for BV prior to IUD insertion is neither currently recommended, nor supported by our study findings.