When do you recheck a chlamydia test following chlamydia treatment?

Chlamydia Retesting After Treatment

Retest all patients approximately 3 months after chlamydia treatment to detect reinfection, not to confirm cure. 1

Key Distinction: Rescreening vs Test-of-Cure

Test-of-Cure (NOT Recommended for Most Patients)

• Do NOT perform test-of-cure in non-pregnant patients treated with azithromycin or doxycycline, unless therapeutic compliance is questionable, symptoms persist, or reinfection is suspected 2, 1
• Testing before 3 weeks after treatment completion is invalid and should be avoided—false-negative results occur from low organism counts, and false-positive results occur from dead organisms still being detected by NAATs 2, 1

Rescreening for Reinfection (Recommended for All)

• All patients should be retested approximately 3 months (12 weeks) after treatment to detect repeat infections, which carry elevated risk for complications like PID compared to initial infections 1
• The 3-month timeframe is optimal because reinfection rates are high (11-16% in women, 9-15% in men) and most result from untreated partners or resuming sex in high-prevalence networks 2, 3
• One study suggests 8 weeks may achieve higher uptake (77%) compared to 16 or 26 weeks (67% and 64%), with similar positivity rates 4

Population-Specific Recommendations

Women (All Ages)

• Retest all women at 3 months after treatment 1
• Retest opportunistically whenever women return for any medical care within 3-12 months after treatment, regardless of whether they believe partners were treated 2, 1
• Adolescent women are especially high priority for rescreening 2

Pregnant Women (Exception to the Rule)

• Test-of-cure IS required for all pregnant women 1
• Perform test-of-cure 3-4 weeks after completing therapy, preferably using NAAT 1
• This exception exists because alternative regimens used in pregnancy (erythromycin, amoxicillin) may be less efficacious and have compliance issues 2

Men

• Retest at 3 months after treatment, though evidence is more limited than for women 2, 1
• Reinfection rates in men are substantial (9-15%), justifying routine rescreening 3

Critical Timing Considerations

Avoid Testing Too Early

• Never test before 3 weeks post-treatment in non-pregnant patients—this produces unreliable results 2, 1
• NAATs can detect dead organisms for weeks after successful treatment, causing false-positive results 2

Optimal Rescreening Window

• 60-183 days (approximately 2-6 months) after treatment is the guideline-recommended window for non-pregnant patients 5
• 3 months (12 weeks) is the sweet spot balancing reinfection detection with patient compliance 1

Partner Management and Prevention

• Patients must abstain from sex for 7 days after single-dose therapy or until completion of 7-day regimens, and until all partners are treated 1
• Evaluate and treat all sex partners who had contact within 60 days before symptom onset or diagnosis 1
• Treat the most recent partner even if contact was >60 days before diagnosis 1
• Most reinfections result from untreated partners, making partner treatment essential to prevent the elevated complication risk from repeat infections 2

Common Pitfalls to Avoid

• Don't confuse test-of-cure with rescreening—they serve different purposes and occur at different timeframes 2, 1
• Don't skip retesting in asymptomatic patients—66% of reinfections are asymptomatic 3
• Don't forget opportunistic retesting—25% of missed retests occur during unrelated return visits 5
• Don't test too early—wait at least 3 weeks to avoid false results from residual organisms 2, 1