What are the recommendations for retesting for chlamydia (Chlamydia trachomatis) after initial treatment?

Chlamydia Retesting Recommendations

All patients treated for chlamydial infection should be retested approximately 3 months after treatment to detect repeat infections, which confer an elevated risk for PID and other complications compared to initial infections. 1

General Retesting Guidelines

• Test-of-cure (repeat testing 3-4 weeks after completing therapy) is NOT recommended for non-pregnant patients treated with the recommended regimens, unless:

  • Therapeutic compliance is in question
  • Symptoms persist
  • Reinfection is suspected 1

• Retesting (distinct from test-of-cure) is recommended for all patients approximately 3 months after treatment due to high rates of reinfection 1

• Diagnostic testing performed less than 3 weeks after treatment completion is not valid because:

  • False-negative results may occur due to persistent infections with limited numbers of organisms
  • False-positive results may occur due to continued presence of dead organisms 1

Population-Specific Recommendations

Women

• All women with chlamydial infection should be retested approximately 3 months after treatment 1
• Providers should retest all women treated for chlamydial infection whenever they next seek medical care within the following 3-12 months, regardless of whether the patient believes their partners were treated 1
• Repeat infections are common in women (14.2% positivity on retesting) and confer elevated risk for PID and other complications 2

Men

• Limited evidence exists on the benefit of retesting men, but specialists suggest retesting men approximately 3 months after treatment 1
• Men have high rates of repeat infection (15.9% positivity on retesting), supporting the need for retesting 2

Pregnant Women

• Test-of-cure IS recommended for all pregnant women 3-4 weeks after completion of therapy 1
• Preferably using nucleic acid amplification test (NAAT) to ensure therapeutic cure, considering the sequelae that might occur in mother and neonate if infection persists 1

Optimal Timing for Retesting

• The most recent evidence suggests 8 weeks after initial diagnosis and treatment may be optimal for retesting, as it provides the highest retest uptake while maintaining similar positivity rates compared to later retesting intervals 3
• Traditional recommendations have suggested 3 months (12 weeks) after treatment 1
• Studies show the risk for infection remains high at both 3-6 months (16.3 per 100 three-month intervals) and 9-12 months (12.0 per 100 three-month intervals) after initial infection 4

Barriers and Implementation

• Current adherence to retesting recommendations is suboptimal:

  • Only 22.3% of men and 38.0% of non-pregnant women get retested as recommended 2
  • Only 22.0% of pregnant women receive a test-of-cure within the recommended timeframe 2

• Clinic-level policies and prioritization of retesting significantly improve retesting rates 5

Risk Factors for Reinfection

• Most post-treatment infections result from reinfection due to:

  • Sex partners not being treated
  • Resumption of sex with a new infected partner 1
  • Incomplete treatment of the initial infection 6

• Black individuals and those with STIs at baseline are at highest risk for recurrent infection (adjusted odds ratio 2.5 and 2.4, respectively) 4

Prevention of Reinfection

• Patients should abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen 1
• Patients should abstain from sexual intercourse until all sex partners have been treated 1
• Sex partners should be evaluated, tested, and treated if they had sexual contact with the patient during the 60 days preceding symptom onset or diagnosis 1
• The most recent sex partner should be evaluated and treated even if the last sexual contact was >60 days before symptom onset or diagnosis 1