When to repeat a test of cure for Chlamydia (Chlamydia trachomatis)?

When to Repeat Test of Cure for Chlamydia

Test of cure for chlamydia is not recommended for non-pregnant patients treated with standard regimens (doxycycline or azithromycin) unless symptoms persist or reinfection is suspected. 1

General Recommendations

• Standard cases (non-pregnant patients):

  • No test of cure needed after completing treatment with doxycycline or azithromycin
  • Exception: If symptoms persist or reinfection is suspected

• Special populations requiring test of cure:

  • Pregnant women: Test of cure recommended 3 weeks after treatment completion 1, 2
  • Patients treated with erythromycin: Consider test of cure 3 weeks after treatment 1
  • Patients with questionable compliance: Test of cure may be appropriate 1

Timing of Test of Cure (When Required)

• Minimum waiting period: 3 weeks after treatment completion 1
• Pregnant patients: Test of cure at 4 weeks after treatment 2

Rationale for Not Performing Routine Test of Cure

• Standard treatments (doxycycline and azithromycin) are highly efficacious 1
• Tests performed too early (<3 weeks) may yield:
  • False-negative results due to small numbers of organisms 1
  • False-positive results due to continued excretion of dead organisms 1

Important Caveats

• Testing methodology matters: Culture is preferred for test of cure when available 3
• Intermittent positive patterns: Research shows that up to 42% of treated infections may test positive on at least one sample after 3 weeks, suggesting caution in interpreting single test results 4
• Distinguishing test of cure from rescreening: Test of cure (for treatment failure) is different from rescreening (for reinfection) 1

Rescreening Recommendations (Different from Test of Cure)

• All patients with chlamydia should be rescreened approximately 3 months after treatment 1, 2
• Women should be rescreened whenever they next present for care within 3-12 months after treatment 1
• This rescreening is important because:
  • High prevalence of reinfection in previously infected individuals
  • Reinfection carries elevated risk of complications (PID) compared to initial infection 1

Partner Management to Prevent Reinfection

• Patients should abstain from sexual intercourse until:
  • They complete treatment (7 days after single-dose therapy or after completion of 7-day regimen)
  • All sex partners are treated 1
• Sex partners from the previous 60 days should be evaluated, tested, and treated 1