From the Guidelines
Chlamydia should not be routinely followed up with a test of cure in non-pregnant patients who have completed the recommended treatment regimen and have no ongoing symptoms. However, a test of cure is recommended for pregnant women at a minimum of 3 weeks following treatment to identify persisting or repeat infection so that repeat treatment can be provided promptly to reduce risk for maternal and neonatal morbidity, as stated in the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines 1. The standard treatment for uncomplicated chlamydia is typically a single 1-gram dose of azithromycin taken orally, or doxycycline 100mg taken twice daily for 7 days. For most non-pregnant patients who complete the recommended treatment regimen and have no ongoing symptoms, a test of cure is unnecessary because the treatments are highly effective with cure rates exceeding 95% 2. Some key points to consider in the management of chlamydia include:
- Treatment with CDC-recommended therapy to reduce complications and prevent transmission to others
- Treatment of sexual partners to prevent reinfection of patients and complications in patients and partners
- Risk-reduction counseling
- Repeat CT testing a few months following treatment to identify repeat infection, which is not a test of cure but rather a check for reinfection 1. Patients should also abstain from sexual activity for 7 days after single-dose therapy or until completion of a 7-day regimen to prevent transmission before treatment is effective. It's also advised to consider a test of cure for patients who received non-standard treatment regimens, those with persistent symptoms despite treatment, or when medication adherence is questionable, as noted in the 2006 sexually transmitted diseases treatment guidelines 2.
From the Research
Test of Cure for Chlamydia
- The need for a test of cure (TOC) for chlamydia is a topic of discussion among healthcare professionals, with varying recommendations based on different guidelines and studies 3, 4, 5.
- According to a study published in the American Family Physician, pregnant patients diagnosed with chlamydia should have a test of cure four weeks after treatment 3.
- However, another study published in PloS One found that a test of cure within 3-5 weeks is not recommended for Chlamydia trachomatis (CT) 4.
- A feasibility study published in Sexually Transmitted Infections estimated the time to test of cure for Neisseria gonorrhoeae and Chlamydia trachomatis infections, suggesting that it may be possible to undertake TOC for these infections earlier than current guidelines suggest 5.
Treatment and Retesting Practices
- The effectiveness of different treatments for chlamydia, such as doxycycline and azithromycin, has been compared in several studies 6, 7.
- A study published in The Lancet Infectious Diseases found that the microbiological anorectal cure rate was significantly lower among women who received a single dose of azithromycin than among those who received a 1-week course of doxycycline 6.
- Another study published in Clinical Infectious Diseases found that the effectiveness of doxycycline is high and exceeds that of azithromycin for the treatment of rectal CT infections in women 7.
- Retesting practices for chlamydia and Neisseria gonorrhoeae were assessed in a study published in PloS One, which found that retesting rates were low for both CT (24%) and NG (15%) 4.