Identifying Patients for Retesting

One practice-based factor that leads to low retesting rates is lack of a consistent method for identifying patients due for retesting when they visit the office for another reason. To prevent missed opportunities for retesting, it is recommended to institute system-level interventions, such as paper or electronic chart prompts (“pop-ups”), to flag the need for a retest.

If feasible, institute a recall system by generating routine chlamydia/gonorrhea retest reports to identify and follow-up with patients who have not been retested within three months.

Since patients at risk for one infection are often at risk for both, patients treated for either chlamydia or gonorrhea should be retested for both, regardless of their initial test results.

If your lab uses nucleic acid amplification tests (NAATs) for chlamydia and gonorrhea diagnosis (the test technology used for chlamydia/gonorrhea testing by the vast majority of laboratories nationwide), patients should not be retested less than three weeks post-treatment due to the risk of false-positive test results. In general, a test of cure is not recommended for non-pregnant patients.

Getting Patients to Return for Testing

Patients may have a lack of knowledge or understanding about why it is important to come back for a retest within a few months after being treated for chlamydia. To ensure patients are well-informed, train staff to provide comprehensive counseling and education at the treatment visit. It’s important to stress the following points:

  • Reinfections are very common—as many as 1 in 5 people will have a repeat infection with chlamydia within the first few months after they are treated for their initial infection.
  • Women who have multiple chlamydial infections are at increased risk for serious reproductive complications, including pelvic inflammatory disease and future risk of ectopic pregnancy. This can also affect their ability to get pregnant in the future. This also applies to transmen who still have their female reproductive organs.
  • Untreated chlamydia may increase a person’s chances of acquiring or transmitting HIV—the virus that causes AIDS.
  • Women who are infected with chlamydia rarely have any symptoms and so are unlikely to be aware that anything is wrong.

These messages can also be reinforced with written patient education materials, such as chlamydia and gonorrhea fact sheets, or small information cards that can fit in one’s pocket or wallet and also include the patient’s target retest date. Additionally, electronic health record (EHR) reminders are a useful way to prompt staff to remind patients to return for retesting.

Patients may also forget to return for the retest visit. Some ways to encourage a return visit include:

  • Helping patients find a way to remember to schedule their retest appointments, such as by adding a reminder in their cell phone.
  • Have patients sign up for a reminder by postcard, email, or text. Patients can choose what method they would like to be contacted by.
  • If they choose postcards, fill out a discreet reminder postcard that your clinic can send to them a month before their retest is due.
  • If they choose text or email, you can sign up for Bedsider’s free service to offer your patients email and text message retest reminders that are discrete and customized for your practice.

While patients should be counseled to return for a repeat test approximately three months post- treatment, ensure that staff is opportunistically retesting patients whenever they next return, regardless of their reason for the visit, during the one to twelve months after their treatment visit.

If your patient population is very unlikely to return for a follow-up appointment in 3 months, consider counseling patients to return for retesting earlier than 3 months, e.g., at 6 weeks.