From the Guidelines
A test of cure for chlamydia is not recommended for most people, except in certain situations such as pregnant women, cases where symptoms persist, when medication compliance was questionable, or if reinfection is possible due to an untreated partner, as stated in the 2006 guidelines 1. After completing the standard treatment, most people don't need a test of cure if symptoms resolve. However, a follow-up test is recommended 3-4 weeks after treatment for the aforementioned situations. This timing allows for clearance of any residual DNA that might cause false positive results with nucleic acid amplification tests. Some key points to consider include:
- The validity of chlamydial diagnostic testing at <3 weeks after completion of therapy has not been established, and false-negative results might occur because of persistent infections involving limited numbers of chlamydial organisms 1.
- Nonculture tests conducted at <3 weeks after completion of therapy in persons who were treated successfully could yield false-positive results because of the continued presence of dead organisms 1.
- All persons treated for chlamydia should be retested approximately 3 months after treatment, regardless of whether they believe their partners were treated, as reinfection rates are high 1. If you can't return for this test, you should be retested whenever you next seek medical care within the 12 months following treatment. It's also important to note that the 2006 guidelines 1 are the most recent and relevant to this question, and they should be prioritized over older guidelines.
From the Research
Test of Cure for Chlamydia
- A test of cure is recommended for certain individuals after being treated for chlamydia, as stated in the study 2.
- Pregnant patients diagnosed with chlamydia should have a test of cure four weeks after treatment, according to 2.
- Nonpregnant individuals should be tested for reinfection approximately three months after treatment or at the first visit in the 12 months after treatment, as mentioned in 2.
- The time to obtain a negative chlamydia nucleic acid amplification test (NAAT) after treatment was found to be significantly different between pregnant and nonpregnant women, with a median of 8 days for pregnant women and 7 days for nonpregnant women, as reported in 3.
- Clinicians should collect a test-of-cure in pregnant women no earlier than 1 month after treatment, and women should avoid condomless intercourse for at least 1 month to avoid reinfection, as recommended in 3.
Treatment Efficacy
- Doxycycline and azithromycin are both used to treat chlamydia, but their efficacy may vary, as discussed in 4 and 5.
- A meta-analysis found that doxycycline may have a slightly higher efficacy than azithromycin for the treatment of urogenital chlamydia, with a pooled efficacy difference of 1.5% to 2.6%, as reported in 4.
- A systematic review and meta-analysis found that doxycycline had a higher microbiological cure rate than azithromycin for the treatment of rectal chlamydia, with a risk ratio of 1.21, as stated in 5.
- A randomized controlled trial found that doxycycline was significantly more effective than azithromycin for the treatment of rectal chlamydia in men who have sex with men, with a microbiologic cure rate of 100% versus 74%, as reported in 6.