In the JournalsPerspective

Many patients with chlamydia fail to receive recommended retest

Few people who are treated for chlamydia are retested for the disease, according to data from CDC researchers.

“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 partner,” Karen Hoover, MD, MPH, medical epidemiologist in the CDC’s Division of STD Prevention, told Infectious Disease News. “CDC recommends that men and women with chlamydia be retested 3 to 12 months after treatment. Among women, repeated chlamydia infections can increase the risk for pelvic inflammatory disease. Chlamydial infection also increases the risk of HIV transmission.”

The researchers used data from a US laboratory that included all chlamydia tests performed in men and women from July 1, 2008, to July 31, 2010. During this time period, there were 3.32 million tests performed, of which 2.92 million were among women. The researchers estimated the repeat testing rates of men and women who tested positive for chlamydia during the first 6 months of the study period, allowing at least 12 months of follow-up for each person.

Among the men, 7% of tests were positive, and among women, 4% of the tests were positive. Men aged 17 to 23 years had the highest number of positive tests, and among women, those aged 15 to 19 years had the highest number of positive tests.

Among men, 22.3% with a positive test had a retest vs. 38% of nonpregnant women who had a positive test. Among pregnant women, 60.1% of those with a positive test were retested. The retests were positive in 15.9% of men, 14.2% of nonpregnant women and 15.4% of pregnant women. Test-of-cure, recommended 3 to 4 weeks after treatment for pregnant women with chlamydia, was performed in 22% of pregnant women with a positive test.

“Health care providers can help patients diagnosed with chlamydia to understand the importance of returning to be retested 3 to 12 months after treatment,” Hoover said. “Treating their partners is also important, either by referral to a health care provider or by expedited partner therapy. 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.”

Disclosure: Hoover reports no relevant financial disclosures.

Few people who are treated for chlamydia are retested for the disease, according to data from CDC researchers.

“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 partner,” Karen Hoover, MD, MPH, medical epidemiologist in the CDC’s Division of STD Prevention, told Infectious Disease News. “CDC recommends that men and women with chlamydia be retested 3 to 12 months after treatment. Among women, repeated chlamydia infections can increase the risk for pelvic inflammatory disease. Chlamydial infection also increases the risk of HIV transmission.”

The researchers used data from a US laboratory that included all chlamydia tests performed in men and women from July 1, 2008, to July 31, 2010. During this time period, there were 3.32 million tests performed, of which 2.92 million were among women. The researchers estimated the repeat testing rates of men and women who tested positive for chlamydia during the first 6 months of the study period, allowing at least 12 months of follow-up for each person.

Among the men, 7% of tests were positive, and among women, 4% of the tests were positive. Men aged 17 to 23 years had the highest number of positive tests, and among women, those aged 15 to 19 years had the highest number of positive tests.

Among men, 22.3% with a positive test had a retest vs. 38% of nonpregnant women who had a positive test. Among pregnant women, 60.1% of those with a positive test were retested. The retests were positive in 15.9% of men, 14.2% of nonpregnant women and 15.4% of pregnant women. Test-of-cure, recommended 3 to 4 weeks after treatment for pregnant women with chlamydia, was performed in 22% of pregnant women with a positive test.

“Health care providers can help patients diagnosed with chlamydia to understand the importance of returning to be retested 3 to 12 months after treatment,” Hoover said. “Treating their partners is also important, either by referral to a health care provider or by expedited partner therapy. 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.”

Disclosure: Hoover reports no relevant financial disclosures.

    Perspective
    Khalil Ghanem, MD, PhD

    Khalil Ghanem

    This is one of many papers that have come out which show that retesting rates among people infected with chlamydia are extremely low. This is not surprising. This is important because reinfection rates are exceedingly high among persons treated for chlamydia. To try and mitigate the sequelae of these infections (e.g. pelvic inflammatory disease, ectopic pregnancies, chronic pelvic pain), the recommendation is to retest all people treated for chlamydia 3 months after therapy, or at their next scheduled visit. Like others, this paper shows that retesting rates are very low. However, the study has limitations. If someone was retested elsewhere that did not use this laboratory, they would not have been picked up. So, although the retesting rates in this study are an underestimate, the real retesting rates are probably not much higher. It is imperative that clinicians who treat people with chlamydia bring them back within three months for retesting.

    • Khalil Ghanem, MD, PhD
    • Associate professor of medicine, Johns Hopkins University School of Medicine

    Disclosures: Dr. Ghanem reports no relevant financial disclosures.