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Background Limited evidence suggests that the non-hormonal contraceptive copper intrauterine device (Cu-IUD) may increase bacterial vaginosis (BV) risk, possibly due to increased volume and duration of menses, a common side effect of Cu-IUD use. While increases in bleeding typically resolve within 6-12 months following initiation, evaluations of the association between Cu-IUD and BV have not included more than six months of follow-up. Methods This secondary analysis of an HIV-1 prevention trial included 2,585 African women ages 18-45 fol