What is the recommended STD testing and treatment approach for someone with a history of chlamydia who hasn't been retested in years?

Comprehensive STD Testing and Management for Patient with Remote Chlamydia History

This patient requires immediate comprehensive STD screening including gonorrhea, chlamydia, trichomonas, HIV, syphilis (RPR), hepatitis B and C, and HSV-1/2 serology, with retesting at 3 months for HIV and syphilis if initial tests are negative. 1, 2

Immediate Testing Panel

Bacterial STI Screening (NAAT-based)

• Chlamydia and gonorrhea testing using nucleic acid amplification tests (NAATs) on first-void urine or genital specimens (vaginal swab for females, urine for males) 1
• Site-specific testing based on sexual exposure history: collect pharyngeal specimens if receptive oral sex, rectal specimens if receptive anal intercourse 1, 2
• Trichomonas testing using vaginal NAAT for women (most sensitive method) 1, 2

Serologic Testing

• HIV testing using laboratory-based antigen/antibody combination test 2
• Syphilis screening with RPR or VDRL plus treponemal-specific test 1, 2
• Hepatitis B surface antigen, surface antibody, and core antibody 2
• Hepatitis C antibody with reflex RNA testing if positive 2
• HSV-1 and HSV-2 type-specific IgG serology 2

Critical 3-Month Follow-Up Testing

The initial screening is insufficient to rule out all infections due to window periods. 2

• Repeat HIV testing at 3 months (4-6 weeks minimum) as the window period for laboratory Ag/Ab tests means early infection may be missed initially 2
• Repeat syphilis serology at 6-12 weeks if initial test was negative, as early primary syphilis may not be serologically detectable 2
• If initial chlamydia or gonorrhea tests were positive and treated, mandatory retesting at 3 months due to reinfection rates of 25% within 3.6 months for chlamydia and 6 months for gonorrhea 1, 2

Treatment Approach if Positive Results

For Chlamydia

• Azithromycin 1 g orally as single dose OR doxycycline 100 mg orally twice daily for 7 days 1, 3
• Abstain from sexual intercourse for 7 days after single-dose therapy or until completion of 7-day regimen 1
• All sex partners from preceding 60 days must be evaluated, tested, and treated 1

For Gonorrhea

• Follow current CDC treatment guidelines (typically ceftriaxone-based regimens) 1
• Same partner notification and abstinence recommendations as chlamydia 1

For Trichomonas

• Metronidazole 2 g orally as single dose OR tinidazole 2 g orally as single dose 1
• Consider rescreening females at 3 months after treatment 1

Ongoing Screening Recommendations

Annual Screening Criteria

• All sexually active women ≤25 years require annual chlamydia and gonorrhea screening 1
• Women >25 years with risk factors (new or multiple partners, partner with concurrent partners, inconsistent condom use, previous STI, exchanging sex for money/drugs) 1

High-Risk Populations Requiring More Frequent Screening (Every 3-6 Months)

• Men who have sex with men engaging in receptive oral or anal intercourse 1
• Individuals with multiple or anonymous partners 1, 2
• Sex in conjunction with illicit drug use 1, 2
• History of previous STIs 1, 2

Critical Pitfalls to Avoid

Failing to test exposure-specific anatomic sites misses substantial infections, particularly pharyngeal and rectal gonorrhea in men who have sex with men 2. The urethra alone is insufficient if other exposures occurred 1.

Do not rely on single-time HIV or syphilis testing to rule out infection—the window period necessitates repeat testing at 3 months 2.

Reinfection is extremely common (25% within 3-6 months), making the 3-month retest after positive chlamydia/gonorrhea mandatory regardless of whether partners were reportedly treated 1, 2.

Partner treatment is non-negotiable—consider expedited partner therapy (providing prescription directly to partner) if the partner cannot access care 1.