Do tests of cure need to be performed for gonorrhea and syphilis after completing treatment?

Test of Cure Requirements for Gonorrhea and Syphilis

For gonorrhea, routine test of cure is NOT needed after standard recommended treatment, but IS required when alternative regimens are used, for pharyngeal infections, or if symptoms persist; for syphilis, serological follow-up is mandatory in all cases to confirm cure. 1, 2

Gonorrhea Test of Cure

When Test of Cure is NOT Required

• Patients receiving standard recommended treatment (ceftriaxone) for uncomplicated urogenital or rectal gonorrhea do NOT need routine test of cure 3, 1
• This applies only when patients are asymptomatic after completing therapy and have no concerns for reinfection 3

When Test of Cure IS Required

• Alternative treatment regimens: Test of cure should be performed 1 week after treatment 1
• Pharyngeal gonorrhea: Always requires test of cure due to higher treatment failure rates 1, 4
• Persistent symptoms: Any patient with ongoing symptoms after completing therapy needs re-evaluation 3, 1
• Suspected treatment failure: Culture with antimicrobial susceptibility testing is essential 1

Timing and Method for Gonorrhea Test of Cure

• Culture is the preferred method when available, as it allows antimicrobial susceptibility testing and is essential for suspected treatment failures 1
• If culture unavailable, NAAT can be used but timing is critical to avoid false positives from residual DNA 1, 5
• Timing for NAAT: At least 7 days for RNA-based tests (Aptima) or 14 days for DNA-based tests (Cobas) after treatment 1, 5, 6
• Research demonstrates median clearance time of 2 days for RNA-based NAAT (range 1-7 days) and up to 15 days for DNA-based NAAT 5

Critical Pitfall to Avoid

• Failing to obtain culture in treatment failure cases is a major error, as culture is the only way to perform antimicrobial susceptibility testing and detect emerging resistance 1
• Report suspected treatment failures to local public health officials within 24 hours 1

Syphilis Serological Follow-Up

Mandatory Follow-Up for All Cases

• Unlike gonorrhea, syphilis requires serological follow-up in ALL treated patients to confirm cure and detect possible reinfections 2
• This is not technically a "test of cure" but rather monitoring for appropriate serological response to treatment 2

Follow-Up Protocol

• Non-treponemal antibody titers (RPR or VDLR) should be monitored at specific intervals after treatment 2
• The goal is to document a four-fold decline in titers, which indicates successful treatment 2
• Failure to show appropriate serological response may indicate treatment failure or reinfection 2

Reinfection Screening (Distinct from Test of Cure)

For Both Gonorrhea and Syphilis

• All patients diagnosed with gonorrhea should be retested at 3-6 months due to high reinfection rates, regardless of whether partners were treated 3, 1
• This reinfection screening is separate from test of cure and addresses the reality that most post-treatment infections result from reinfection rather than treatment failure 3

Partner Management is Essential

• All sex partners within the preceding 60 days must be evaluated and treated for both infections 1, 7
• Patients should abstain from sexual intercourse until therapy is completed and both patient and partners are asymptomatic 1, 7
• Consider expedited partner therapy if partners' treatment cannot be ensured 1, 7