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Chlamydia/Gonorrhea Retesting | Questions & Answers | 2010 Treatment Guidelines

Question 1: What is the difference between chlamydia test of cure and three-month rescreening for chlamydia?

Answer: Test of cure is testing for treatment failure, i.e., persistence of infection despite treatment. Rescreening may occasionally detect persistent infection, but most prevalent infections at rescreening are reinfections, either from an untreated prior partner or from an infected new partner. Operationally, a test of cure is typically performed a week or two following completion of therapy while rescreening is carried out several months later. See 2010 STD Treatment Guidelines, pages 7, 46, and 52.

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Question 2: Is it accurate to say that a test of cure is generally performed on pregnant women due to noncompliance issues such as continuing to have sex with a nontreated partner while on medication, missed doses of medication, etc.?

Answer: The test of cure recommendation for chlamydia treatment in pregnancy is not because of issues of noncompliance, but rather to "ensure therapeutic cure, considering the severe sequelae that might occur in mothers and neonates if the infection persists" (2010 STD Treatment Guidelines, page 47).

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Question 3: Does it make any difference if a patient gets retested for chlamydia or gonorrhea in less than three months?

Answer: The three-month interval is somewhat arbitrary as suggested by the 2010 STD Treatment Guidelines, page 7 ("Retesting several months after a diagnosis of chlamydia or gonorrhea...") and page 46 ("Chlamydia-infected women and men should be retested approximately 3 months after treatment…"). That said, the three-month time interval is probably long enough to avoid false-positive results from nonviable organisms remaining after effective treatment and to allow sufficient time for reinfection from an infected partner to occur, but at the same time short enough to avoid long-term complications from an undetected and untreated infection, and to be remembered by the treated patient.

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Question 4: Are there any recent improvements in patient counseling or patient motivation methods to return to clinic for treatment or testing?

Answer: Compliance with the three-month retesting recommendation is very poor without reminders or prompts. To date there is no evidence on interventions to improve retesting rates.

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Question 5: Page 47 of the 2010 STD Treatment Guidelines discusses CT testing during pregnancy by stating "repeat testing (by NAAT) … three weeks after the following regimens." Does this refer to retest only if treated with something besides azithromycin?

Answer: The potential for adverse outcomes of pregnancy and infection of children born to infected mothers typically makes clinicians more cautious in management of pregnant women. The 2010 STD Treatment Guidelines (page 47) recommends repeat testing three weeks after completion of treatment with any recommended (including azithromycin) or alternative regimen.

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