Test of Cure for Chlamydia
Test of cure is NOT recommended for non-pregnant patients treated with standard regimens (azithromycin or doxycycline), unless therapeutic compliance is questionable, symptoms persist, or reinfection is suspected. 1, 2
Key Distinction: Test of Cure vs. Retesting for Reinfection
These are fundamentally different concepts that must not be confused:
Test of Cure (Generally NOT Recommended)
- Timing if indicated: 3-4 weeks after completing therapy 1, 2
- Do NOT test before 3 weeks - testing earlier than 3 weeks post-treatment is invalid because NAATs can yield false-positive results from dead organisms and false-negative results from persistent infections with limited organism numbers 1, 2
- Exception - Pregnant women: Test of cure IS recommended for all pregnant patients at 3-4 weeks post-treatment, preferably using NAAT 2
- Other indications for test of cure: Poor compliance, persistent symptoms, suspected reinfection, or treatment with alternative regimens like erythromycin 1
Retesting for Reinfection (Strongly Recommended)
- All patients should be retested approximately 3 months after treatment to detect reinfection, which carries elevated risk for complications like PID compared to initial infection 1, 2
- Women should be retested whenever they present for care within 3-12 months after treatment, regardless of whether partners were treated 1, 2
- Men with documented chlamydia should be retested 3-6 months after treatment due to high reinfection rates 1
Method of Testing
- NAAT (nucleic acid amplification test) is preferred for both test of cure and reinfection screening 2
- Modern RNA-based and DNA-based NAATs are both acceptable 3
Critical Timing Considerations
The 3-week minimum waiting period is based on clearance data:
- Research shows median clearance time is 7-10 days for chlamydia DNA/RNA 3, 4, 5
- By day 14, approximately 89-95% of patients have cleared detectable nucleic acids 3, 5
- However, intermittent positive results ("blips") can occur even after clearance, with risk of 1.7-4.4% 3
- All patients should clear by 29-30 days post-treatment 6
Patient Instructions to Prevent Reinfection
- Abstain from sexual intercourse for 7 days after single-dose therapy (azithromycin) or until completion of 7-day regimen (doxycycline) 1, 2
- Continue abstinence until all sex partners are treated 1, 2
- Sex partners from the preceding 60 days should be evaluated, tested, and treated 1, 2
- The most recent partner should be treated even if contact was >60 days before diagnosis 1, 2
Common Pitfalls to Avoid
- Do not confuse test of cure with reinfection screening - they serve different purposes and have different timing 1, 2
- Do not test before 3 weeks unless using culture methods, as NAATs will frequently show false-positive results from dead organisms 1
- Do not skip the 3-month reinfection screening - this is where the real clinical benefit lies, as reinfection rates are high and carry increased complication risk 1, 2
- Do not forget pregnant patients require test of cure - they are the exception to the general rule 2