When should a patient with a history of gonorrhea be retested after completion of treatment for gonorrhea?

When to Retest After Treatment for Gonorrhea

Retest all patients with gonorrhea 3 months after treatment, regardless of whether they believe their sex partners were treated. 1

Rationale for 3-Month Retesting

The high prevalence of reinfection drives this recommendation:

• Most post-treatment infections represent reinfection rather than treatment failure, indicating inadequate partner treatment or new exposures 1
• Patients who have had gonorrhea face substantially elevated risk of acquiring a new infection in the subsequent months 1
• This retesting is distinct from test-of-cure, which is not recommended for patients treated with standard regimens 1

Test-of-Cure: When It Is NOT Needed

Patients with uncomplicated gonorrhea treated with recommended regimens (ceftriaxone plus azithromycin) do not require test-of-cure. 1, 2

Test-of-Cure: When It IS Required

Test-of-cure is mandatory in specific circumstances:

• Alternative regimens: Patients receiving cefixime or azithromycin monotherapy require test-of-cure at 1 week after treatment 2
• Persistent symptoms: Any patient with ongoing symptoms after treatment should undergo culture with antimicrobial susceptibility testing 1, 2
• Pharyngeal infections treated with spectinomycin: Test pharyngeal culture 3-5 days after treatment due to only 52% efficacy 1, 2
• Suspected treatment failure: Obtain culture with susceptibility testing immediately and report to public health within 24 hours 2

Timing Considerations

• Test-of-cure timing: When required, perform at 1 week for alternative regimens or 2 weeks for nucleic acid amplification tests (NAATs) 2, 3
• Reinfection screening: 3 months after treatment for all patients 1
• Opportunistic testing: If patients don't return at 3 months, test whenever they next seek care within 12 months 1

Special Population: Pregnant Women

Pregnant women require more intensive follow-up:

• Retest in the third trimester if antenatal gonococcal infection was diagnosed, unless recently treated 4
• For first-trimester diagnosis, retest 3 months after treatment 1

Common Pitfalls to Avoid

• Do not confuse test-of-cure with reinfection screening: Test-of-cure detects treatment failure (rarely needed); 3-month retesting detects reinfection (always recommended) 1
• Do not skip retesting based on partner treatment status: High reinfection rates occur even when patients report partner treatment 1
• Do not use NAATs too early: If test-of-cure is needed, wait at least 2 weeks to avoid false-positive results from residual nucleic acid 3
• Do not forget to test for other STIs: Screen for chlamydia, syphilis, and HIV at the time of gonorrhea diagnosis and retesting 2, 5

Strategies to Improve Return Rates

• Phone reminders are most effective for increasing return rates (18-fold improvement) 6
• Monetary incentives alone do not significantly improve return rates 6
• Motivational counseling combined with phone reminders increases return rates 2.6-fold 6