From the Guidelines
Yes, a test of cure for chlamydia should be performed approximately 3 months after treatment to ensure the infection has been resolved. This follow-up testing is recommended because reinfection rates are high, particularly in the first few months after treatment 1. The standard treatment for uncomplicated chlamydia is typically a single 1-gram dose of azithromycin taken orally, or doxycycline 100 mg taken orally twice daily for 7 days. After completing treatment, patients should abstain from sexual activity for 7 days to prevent transmission while the antibiotics are working.
Key Considerations
- The 3-month follow-up test is preferred over earlier testing because nucleic acid amplification tests (NAATs) can detect non-viable bacterial DNA for several weeks after successful treatment, potentially leading to false-positive results.
- Patients should be counseled about partner notification and treatment to prevent reinfection, and should use barrier methods like condoms consistently until both partners have completed treatment and follow-up testing confirms resolution of the infection.
- The Centers for Disease Control and Prevention (CDC) recommends retesting all patients diagnosed with chlamydial or gonococcal infection 3 months after treatment, regardless of whether they believe their partners have been treated 1.
Supporting Evidence
- A study published in the Annals of Internal Medicine in 2014 found that the CDC recommends retesting all patients diagnosed with chlamydial or gonococcal infection 3 months after treatment 1.
- Another study published in MMWR Recommendations and Reports in 2002 found that repeat infection confers an elevated risk of PID and other complications when compared with initial infection, highlighting the importance of repeat testing 1.
- A more recent study published in the Annals of Internal Medicine in 2014 also recommends retesting all patients diagnosed with chlamydial or gonococcal infection 3 months after treatment, regardless of whether they believe their partners have been treated 1.
From the Research
Chlamydia Testing After Treatment
- A chlamydia test should be performed 3 months after treatment to confirm resolution of the infection and to identify possible reinfection, as recommended by 2 and 3.
- The purpose of the test is to establish whether the treatment has been effective and to ensure that the patient has not been reinfected by a partner who did not receive treatment, as stated in 4.
- Retesting rates are often suboptimal, with studies showing that only 22.3% of men and 38.0% of nonpregnant women are retested, as reported in 5.
- Factors associated with increased chlamydia re-testing and re-infection include older age, female gender, living with HIV, being a current sex worker, and higher numbers of sex partners, as found in 6.
Recommended Testing Schedule
- The recommended testing schedule is to retest all men and women with a positive test 3 months after treatment, as stated in 2 and 5.
- Pregnant women with a positive test should have a test-of-cure 3-4 weeks after treatment, as recommended in 2 and 5.
- Retesting should be performed later than two weeks after completion of treatment to avoid false positive tests, as noted in 4.
Importance of Retesting
- Retesting is crucial to prevent complications such as pelvic inflammatory disease and infertility, and to decrease community and vertical neonatal transmission, as emphasized in 2 and 3.
- Retesting can help identify individuals who are at high risk of reinfection and provide an opportunity for targeted interventions, such as patient-delivered partner therapy, as discussed in 6.