From the Guidelines
Retesting for chlamydia and gonorrhea is recommended 3 months after initial treatment, regardless of whether patients believe they were re-exposed. This recommendation is based on the high likelihood of reinfection, as stated by the CDC 1. For patients who are unlikely to return for this follow-up, retesting can be performed as early as 4 weeks after completing treatment. The recommended treatment for uncomplicated chlamydia is doxycycline 100 mg orally twice daily for 7 days, or alternatively azithromycin 1 gram orally as a single dose. For gonorrhea, the current recommended treatment is ceftriaxone 500 mg intramuscularly as a single dose (increased to 1 gram for individuals weighing ≥150 kg) 1.
Some key points to consider when retesting for chlamydia and gonorrhea include:
- Retesting is crucial because reinfection rates are high, particularly among young women and men who have sex with men 1.
- Reinfection increases the risk of complications such as pelvic inflammatory disease and infertility in women.
- Additionally, retesting helps identify treatment failures, which is particularly important for monitoring antimicrobial resistance in gonorrhea 1.
- Patients should be advised to abstain from sexual activity for 7 days after treatment completion and until all partners have been treated to prevent reinfection.
- The American Academy of Pediatrics recommends routine annual screening for chlamydia and gonorrhea in all sexually active females aged 25 years or younger, and routine annual screening for rectal and urethral chlamydia in sexually active adolescent and young adult males who have sex with males 1.
It is essential to prioritize retesting for chlamydia and gonorrhea to prevent reinfection and reduce the risk of complications, as recommended by the CDC and other organizations 1.
From the Research
Chlamydia and Gonorrhea Retesting
- The studies provided do not directly address the topic of retesting for chlamydia and gonorrhea, but they do discuss the treatment and diagnosis of these infections 2, 3, 4, 5, 6.
- According to the 2021 CDC STI Treatment Guidelines, patients with gonorrhea should be treated with 500mg ceftriaxone intramuscularly once, and if coinfection with chlamydia has not been excluded, cotreatment with doxycycline 100mg twice daily for 7 days should be added 2.
- A study comparing azithromycin and doxycycline for the treatment of non-gonococcal urethritis and chlamydial cervicitis found that both drugs were effective, but there were no statistically significant differences between them in terms of clinical efficacy 3.
- Another study found that azithromycin was not noninferior to doxycycline for the treatment of urogenital chlamydia infection, with a treatment failure rate of 3.2% in the azithromycin group compared to 0% in the doxycycline group 4.
- A review of the diagnosis and treatment of sexually transmitted infections found that nucleic acid amplification tests have high sensitivities and specificities for the diagnosis of gonorrhea, chlamydia, and other infections, and that effective treatments include ceftriaxone, doxycycline, and other antibiotics 5.
- A study of extragenital gonorrhea and chlamydia positivity among men who have sex with men found that extragenital screening is important to detect and treat these infections, as they are often asymptomatic and can be undertreated if only urethral testing is performed 6.