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

Abstract

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. 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. 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). 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.