When to obtain a repeat Chlamydia (Chlamydia trachomatis) test?

When to Obtain Repeat Chlamydia Testing

All patients diagnosed with chlamydia should be retested approximately 3 months after treatment to detect reinfection, regardless of whether they believe their partners were treated. 1

Test-of-Cure vs. Retesting for Reinfection

These are two distinct testing scenarios with different timing and indications:

Test-of-Cure (NOT Routinely Recommended)

• Test-of-cure is NOT recommended for non-pregnant patients who received standard treatment (azithromycin or doxycycline) and are asymptomatic, unless therapeutic noncompliance or reinfection is suspected 2
• Testing performed less than 3 weeks after treatment completion is not valid due to false-negative results (from low organism burden) and false-positive results (from dead organisms still present) 2, 1
• Exception: Pregnant women MUST receive test-of-cure 3-4 weeks after completing therapy, preferably using NAAT 2, 1, 3

Retesting for Reinfection (ALWAYS Recommended)

The primary indication for repeat testing is detecting reinfection, not treatment failure.

Timing for All Patients

• Retest at 3 months (approximately 12 weeks) after treatment for all patients with documented chlamydia 2, 1
• The CDC specifically recommends this 3-month interval for both men and women due to high reinfection rates within 6 months of treatment 2
• Alternative timing: Retest at the next clinical visit if it occurs within 3-12 months after treatment, even if not exactly at 3 months 2, 1

Special Populations

• Women (especially adolescents): Retesting is considered an especially high priority due to elevated risk of complications like pelvic inflammatory disease with repeat infections 2
• Pregnant women with continued risk: Retest again in the third trimester if ongoing risk factors are present 2
• Men: Same 3-month retesting recommendation applies, though historically undertested 2

Clinical Rationale

The high reinfection rates justify this approach:

• Reinfection rates of 15-22% are documented when patients are appropriately retested 3, 4, 5
• Most post-treatment infections result from reinfection rather than treatment failure, often because partners were not treated or patients resumed sexual activity in high-prevalence networks 2
• Repeat infections confer elevated risk for complications compared to initial infections 2, 1

Common Pitfalls to Avoid

• Do not test too early: Avoid testing before 3 weeks post-treatment to prevent false results 2, 1
• Do not skip retesting based on partner treatment: Retest regardless of whether the patient believes partners were treated 2
• Do not miss opportunistic retesting: If a patient returns for any reason within 3-12 months, perform the retest even if not scheduled specifically for that purpose 2, 1
• Do not forget pregnant patients need earlier test-of-cure: They require testing at 3-4 weeks AND again at 3 months 2, 1, 3

Patient Instructions During Treatment

• Patients must abstain from sexual intercourse for 7 days after single-dose therapy or until completion of 7-day regimen 2, 1
• Abstinence should continue until all sex partners are treated 2, 1
• All sex partners within the preceding 60 days should be evaluated, tested, and treated 2, 1