Risks of Vaginal and Sexually Transmitted Infections With Copper Intrauterine Devices Compared to Oral Contraceptives [ID 1262]

INTRODUCTION: Copper intrauterine devices (Cu-IUDs) have been reported to cause an inflammatory response and alter the vaginal microbiome, with some studies suggesting an increased risk for bacterial vaginosis. This retrospective chart review assesses the relative risk of vaginal infections associated with Cu-IUD use compared to oral contraceptive (OC) use. METHODS: TriNetX platform was accessed to analyze risk outcomes of deidentified patient data. Study cohorts were created using ICD-10, Healthcare Common Procedure Coding System (HCPCS), and RxNorm codes for women with Cu-IUDs versus those on OCs, with n=73,123 after matching for age, race, and ethnicity. Statistical analysis within 10 years post-IUD placement used risk ratios (RRs) with 95% CIs to determine significance. RESULTS: Copper IUDs showed increased risk of acute vulvitis (RR 1.88; CI, 1.76–2.01), subacute/chronic vulvitis (RR 1.91; CI, 1.79–2.04), acute vaginitis (RR 1.72; CI, 1.66–1.78), subacute/chronic vaginitis (RR 1.88; CI, 1.77–2.00), gonorrhea (RR 2.53; CI, 2.30–2.78), syphilis (RR 2.32; CI, 2.10–2.56), trichomoniasis (RR 2.14; CI, 1.90–2.41), chlamydia (RR 2.00; CI, 1.85–2.17), candidiasis (RR 1.52; CI, 1.45–1.59), HIV (RR 1.96; CI, 1.78–2.16), anogenital warts (RR 1.38; CI, 1.23–1.55), HSV-2 (RR 1.24; CI, 1.12–1.38), and pelvic inflammatory disease (RR 1.36; CI, 1.25–1.49). Copper IUDs did not show decreased risk compared to OCs for any of the infections analyzed. CONCLUSIONS/IMPLICATIONS: In this chart review, women using Cu-IUDs had increased risk for all genital infections evaluated compared to OC use, warranting further study of the short- and long-term effects of Cu-IUDs on the vaginal microbiome and immune response of the female genital tract.