Repeat Testing After Chlamydia Treatment
Yes, all patients treated for chlamydia should be retested approximately 3 months after treatment to detect reinfection, which carries an elevated risk for complications compared to initial infection. 1
Test-of-Cure vs. Retesting for Reinfection
These are two distinct concepts that require different approaches:
Test-of-Cure (NOT Routinely Recommended)
- Test-of-cure is NOT recommended for non-pregnant patients treated with doxycycline or azithromycin unless therapeutic compliance is questionable, symptoms persist, or reinfection is suspected. 2, 1
- These first-line regimens are highly efficacious, making routine test-of-cure unnecessary. 2
- Testing performed less than 3 weeks after treatment completion is invalid because false-negative results may occur from small numbers of organisms, and false-positive results may occur from continued excretion of dead organisms. 2, 1
Retesting for Reinfection (STRONGLY Recommended)
All patients—both men and women—should be retested approximately 3 months after treatment. 1, 3 This recommendation is based on:
- High rates of reinfection documented in multiple studies, with 13-15% of patients testing positive again within several months. 4, 5
- Repeat infections confer elevated risk for complications including pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain compared to initial infections. 2, 6, 4
- Most post-treatment infections result from reinfection, often because partners were not treated or patients resumed sex within high-prevalence networks. 2, 4
Providers should also retest all women whenever they next present for care within 3-12 months after treatment, regardless of whether the patient believes their partners were treated. 1, 3 This opportunistic retesting is particularly important given that adherence to the 3-month retesting recommendation is suboptimal, with only 22% of men and 38% of women actually returning for recommended retesting. 5
Special Population: Pregnant Women
Pregnant women are the exception and DO require a test-of-cure 3-4 weeks after treatment completion, preferably using nucleic acid amplification testing (NAAT). 1, 3 This is necessary because:
- Alternative regimens used in pregnancy (erythromycin, amoxicillin, azithromycin) may not be as highly efficacious as doxycycline. 2
- Frequent side effects of erythromycin may discourage compliance. 2
- Ensuring cure is critical to prevent neonatal transmission. 2
However, only 22% of pregnant women actually receive test-of-cure within the recommended 4-week timeframe, representing a significant gap in care. 5
Critical Partner Management
To prevent reinfection, the following steps are essential:
- All sex partners from the 60 days preceding symptom onset or diagnosis should be evaluated, tested, and treated. 1, 7
- The most recent sex partner should be treated even if contact was >60 days before diagnosis. 2, 1
- Patients must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen, AND until all partners have been treated. 1, 7
Common Pitfalls to Avoid
- Do not perform testing <3 weeks after treatment completion as this will yield unreliable results. 2, 1
- Do not confuse test-of-cure with retesting for reinfection—they serve different purposes and have different timing. 2, 1
- Do not assume partners were treated—always retest patients when they return for care within 12 months. 1
- Do not forget that men also need retesting—the 3-month retesting recommendation applies equally to men, who have reinfection rates of 15.9%. 2, 5