Finding the Gaps in Retesting for Chlamydia and Gonorrhea: Differences Across High-Volume Testing Departments in an Urban Health Care Setting

Abstract

Background:The Centers of Disease Control and Prevention guidelines recommend that all patients be retested 3 months after a positive chlamydia (CT) or gonorrhea (GC) result. However, retest rates are generally low, and only a quarter of patients return to clinic for retesting. This analysis explored retesting patterns in a high sexually transmitted infection (STI)/human immunodeficiency virus (HIV)-risk setting to illuminate gaps in adherence to guideline recommendations. Methods:Retrospective chart data from a large urban safety-net institution were analyzed descriptively. Patients who received a positive CT/GC test from January to February 2017 were followed up for at least 4 months to assess if retesting occurred within approximately 3 months.Results: Our sample of 207 patients was primarily non-Hispanic Black (92.8%), younger than 25 years (63.3%) and women (60.4%). Over half had been initially diagnosed with CT, one-third with GC, and one-tenth with both CT and GC. Eighty-nine (43.0%) patients were retested during the observed period; mean time between tests was 2.7 months. Retesting was most common in infectious diseases/HIV primary care (73.6%) and obstetrics/gynecology (44.9%). Patients who were first diagnosed in emergency medicine were significantly less likely to be retested. Retested patients included a large number of HIV-positive men (31 of 89 total) and pregnant women (23 of 54 women).Conclusions: Forty-three percent of patients were retested within approximately 3 months of their initial positive CT/GC diagnosis, exceeding previously published rates. Nonetheless, in light of the growing STI epidemic, health care systems should prioritize retesting across high-volume testing specialties, rethink retesting models, and facilitate referrals to ensure that patients receive guideline-recommended, comprehensive STI care.

Trends in Follow-up Testing Among Patients Positive for Chlamydia and Gonorrhea in the Veterans Health Administration, 2013 to 2019

“…The younger male Veteran population typically does not seek VA benefits as much as the older male population in VHA and may be less likely to follow-up regarding repeat testing 22 . Although not evaluated in this study, other studies found that those who have primary care providers, are followed by infectious diseases or obstetrics/gynecology, or were diagnosed in outpatient settings as opposed to inpatient or emergency department settings were more likely to have repeat testing performed 6,7,12 . Other reasons for low retesting rates may be clinicians not educating patients on the importance of retesting or a lack of systems to standardize follow-up care in those with CT/GC infection.…”

“…22 Although not evaluated in this study, other studies found that those who have primary care providers, are followed by infectious diseases or obstetrics/gynecology, or were diagnosed in outpatient settings as opposed to inpatient or emergency department settings were more likely to have repeat testing performed. 6,7,12 Other reasons for low retesting rates may be clinicians not educating patients on the importance of retesting or a lack of systems to standardize follow-up care in those with CT/GC infection. To increase guideline compliance, a potential strategy in VHA could be to have a follow-up appointment automatically setup with the individual's primary care doctor for their repeat testing.…”

“…If retesting at 3 months is not possible, then retesting whenever the patient next seeks medical care within 12 months after initial treatment is recommended 1 . Several studies have shown that, although patients are often treated for CT/GC, they are often not retested for reinfection or screened for other STIs such as human immunodeficiency virus (HIV) and syphilis 2–9 . McWhirter et al 2 found that, among 14- to 24-year-old patients from an urban federally qualified health center system, 39.9% of patients were noted to have CT/GC repeat testing within 2 to 6 months after a positive test result.…”

The Relationship Between Directly Observed Therapy for Chlamydia Infections and Retesting Rates in an Adolescent Population

“…[7][8][9] Retesting rates in the United States remain low, however, with widely varying retesting estimates of 9% to 42% for male and 18% to 43% for nonpregnant female individuals. [10][11][12] Despite the presence of clinical guidelines recommending DOT, little research has assessed the effectiveness of DOT for chlamydia treatment. One study compared the time to treatment between individuals who underwent DOT versus those who had a prescription sent to a pharmacy, and found no significant difference between the 2 groups.…”

“…Health organizations also recommend STI retesting 3 months after treatment because of the increased likelihood of sequalae such as pelvic inflammatory disease or infertility in patients who are reinfected or do not complete treatment 7–9 . Retesting rates in the United States remain low, however, with widely varying retesting estimates of 9% to 42% for male and 18% to 43% for nonpregnant female individuals 10–12 …”