Comparative study of cervical-vaginal microbial flora changes in women using Cu-T380A contraceptive device and LNG-IUS in Ibadan: a two-centre clinical COHORT study

Background: Intrauterine devices cause various changes in the female genital tract which might result in altered microbial flora and risk of genital infections. The aim of this study was to determine the change in bacterial flora of women using Copper-bearing T380A and levonorgestrel intrauterine system and the risk of genital infections.Methods: This was a two-center clinical cohort study of women using Cu-T380A IUD and LNG-IUS in Ibadan, Nigeria. The study was conducted from March to August, 2016 and it involved 130 women (66 Cu-T380A and 64 LNG-IUS) at 2 family planning clinics in Ibadan, Nigeria. The clients were clinically assessed before admission into the study and high vaginal and endocervical swabs were taken before insertion of the devices, and at 3 and 6months after insertion.Results: Fifty-seven clients with LNG and 63 with copper T380A completed the study. The mean age in LNG-IUS was 34.4years (SD= 6.3) and Cu-T380A was 35.4 years (SD=5.6). All participants had one sexual partner. There was no previous or current STIs/PID at recruitment. The organisms isolated included coagulase negative Staphylococcus (CNS), Staphylococcus aureus, Streptococcus spp, Escherichia coli, Candida spp, Neisseria gonorrhoeae and Klebsiella spp. Cu-T380A women had an increase or persistence of CNS, Staphylococci, Klebsiella and Candida at 3 months while in the LNG-IUS group only CNS increased. The HVS revealed that participants with Cu-T380A had higher risks (33.3%) for asymptomatic genital infections than the LNG-IUS (5.3%) group at 6 months (p value <0.001).Conclusions: Cu-T380A has a higher likelihood of altering the microbial flora in the cervix and vagina and therefore encouraging the growth of a variety of other organisms compared to LNG-IUS