Diagnosis and Treatment

Many with Chlamydia Fail to Receive Recommended Retest

Commentary by Karen Hoover, MD, MPH

Retesting for chlamydia several months after treatment is important, because a large percentage of persons will become reinfected by an untreated partner or by a new, infected one. Repeated chlamydial infections in women can increase their risk of pelvic inflammatory disease and its ad-verse outcomes of infertility, and ectopic pregnancy. Chlamydial infection also increases the risk of HIV transmission. CDC recommends that men and women with chlamydia be retested 3-12 months after treatment, and that pregnant women receive a test-of-cure 3-4 weeks after treatment in addition to retesting.

Analysis of chlamydia testing data from a large U.S. laboratory corporation found that 7% of 0.40 million tested men were positive, and 4% of 2.92 million tested women were positive. Retesting of these persons with chlamydia was suboptimal: 22% of men and 38% of nonpregnant women were retested as recommended by CDC. Among pregnant women, 60% were retested, but only 22% received a test-of-cure at 3-4 weeks as recommended by CDC. Prevalence of chlamydial infection was high among persons re-tested: repeat tests were positive in 16% of men, 14% of non-pregnant women, and 15% of pregnant women.

CDC recommends that men and women with chlamydia be retested 3-12 months after treatment.

Interventions, both for providers and for patients, need to be developed, piloted, and implemented to increase adherence to CDC recommendations for chlamydia testing, retesting, and partner treatment. Healthcare providers can help patients diagnosed with chlamydia to understand the importance of returning to be re-tested 3-12 months after treatment. Treating their partners is also important, either by referral to a healthcare provider or by expedited partner therapy.

Hoover K. W., Tao G., Nye M. B., Body B. A. Suboptimal adherence to repeat testing recommendations for men and women with positive Chlamydia tests in the United States, 2008-2010. Clin Infect Dis 2013;56:51-7.