Repeat Testing of Females for Chlamydial Infection: An Evaluation of Current Practices

Background:
The prevalence of chlamydial infection is high among females treated in the preceding several months. Most post-treatment infections result from reinfection, which confers an elevated risk for pelvic inflammatory disease and other complications. CDC recommends retesting all females approximately 3 months after treatment for chlamydia, or whenever they next seek medical care within the following 3–12 months.

Objective:
To pilot a methodology for measuring repeat chlamydia testing and positivity in relation to CDC guidelines, and to establish a baseline measure of repeat testing rates.

Method:
Electronic laboratory data were available from four Region II IPP project areas (New Jersey, New York City, New York State, and Puerto Rico). Data were reviewed for 4,658 unduplicated females who tested positive for Chlamydia trachomatis between January 1 and December 31, 2005. We analyzed the elapsed time between the baseline positive chlamydia test and next chlamydia test, and the repeat positivity rate.

Result:
Among females with a positive chlamydia test, 414 (9.1%) were retested within 22-74 days (3-10 weeks); 233 (5.1%) were retested within 75-99 days (approximately 3 months); and 988 (21.6%) were retested within 100-365 days (approximately 3-12 months). Only 71 (1.6%) were retested within 21 days. Repeat chlamydia positivity was high, ranging from 12.1% among females retested within 3-10 weeks, to 14.2% for those retested at approximately 3 months, and 17.3% for clients retested within 3-12 months.

Conclusion:
Overall, 26.7% of clients who tested positive for chlamydia were retested within the following 3-12 months (75-365 days), per CDC guidelines, with a 16.7% repeat positivity rate.

Implications:
The Region II IPP was able to estimate baseline compliance with CDC guidelines for chlamydia test-of-reinfection. This pilot methodology can be modified and repeated in additional clinic sites and other regions for quality improvement interventions. Providers should consider strategies for ensuring that clients who test positive are retested per CDC guidelines.