From the Guidelines
Repeat testing for gonorrhea clearance is recommended 3-6 months after treatment for all patients, regardless of whether their sex partners were treated, due to the high rate of reinfection within 6 months after treatment. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of repeat testing to detect potential reinfections 1. The standard treatment for uncomplicated gonorrhea typically includes a single 500 mg intramuscular dose of ceftriaxone, which has high efficacy rates. However, testing for clearance should be performed in certain situations: for pregnant individuals at 3-4 weeks after treatment completion; for patients with persistent symptoms despite treatment; when there is concern about possible reinfection; or in cases of pharyngeal gonorrhea, which can be more difficult to eradicate.
When follow-up testing is performed, it should be done using nucleic acid amplification tests (NAATs) no sooner than 2-3 weeks after treatment completion to avoid false positive results from non-viable bacterial DNA. Additionally, all sexual partners from the 60 days prior to diagnosis should be notified, tested, and treated, and patients should abstain from sexual activity until both they and their partners have completed treatment and are symptom-free to prevent reinfection. It is essential to note that infections identified after treatment with one of the recommended regimens usually result from reinfection rather than treatment failure, indicating a need for improved patient education and referral of sex partners 1.
Some key points to consider when deciding on repeat testing for gonorrhea clearance include:
- The high prevalence of N. gonorrhoeae infection in patients who have had gonorrhea in the preceding several months 1
- The importance of patient education and referral of sex partners to prevent reinfection 1
- The need for repeat testing 3-6 months after treatment to detect potential reinfections 1
- The use of NAATs for follow-up testing, which should be done no sooner than 2-3 weeks after treatment completion 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Neisseria gonorrhoeae Testing for Clearance
- Non-pregnant patients should be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment 2, 3, 4
- Pregnant patients diagnosed with gonorrhea should have a test of cure four weeks after treatment 2
- A test-of-cure is not needed for individuals diagnosed with uncomplicated urogenital or rectal gonorrhea who are treated with the recommended or alternative regimens 3, 4
- Pregnant women with antenatal gonococcal infection should be retested in the third trimester unless recently treated 3, 4
Timing of Retesting
- Retesting should be performed at least 3 months after treatment for non-pregnant patients 2, 3, 4
- For pregnant women, retesting should be done in the third trimester unless recently treated 3, 4
- If a test of cure is indicated for anogenital chlamydia, it is recommended to perform it at least 14 days after initiation of treatment, when using modern RNA- and DNA-based assays 5
Considerations for Reinfection
- Repeat N gonorrhoeae infection is prevalent among patients who have been diagnosed with and treated for gonorrhea in the preceding several months 3, 4
- Most of these infections result from reinfection; therefore, clinicians should advise patients with gonorrhea to be retested 3 months after treatment 3, 4