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Repeat Infection With Chlamydia and Gonorrhea Among Females: A Systematic Review of the Literature

Hosenfeld, Christina B. MPH*; Workowski, Kimberly A. MD†‡; Berman, Stuart MD, SCM; Zaidi, Akbar PHD; Dyson, Jeri MD§; Mosure, Debra PHD; Bolan, Gail MD*; Bauer, Heidi M. MD, MPH*

Sexually Transmitted Diseases: August 2009 - Volume 36 - Issue 8 - p 478-489
doi: 10.1097/OLQ.0b013e3181a2a933
Articles

Determining the magnitude of chlamydia and gonorrhea reinfection is critical to inform evidence-based clinical practice guidelines related to retesting after treatment. PubMed was used to identify peer-reviewed English language studies published in the past 30 years that estimated reinfection rates among females treated for chlamydia or gonorrhea. Included in this analysis were original studies conducted in the United States and other industrialized countries that reported data on chlamydia or gonorrhea reinfection in females. Studies were stratified into 3 tiers based on study design. Reinfection rates were examined in relation to the organism, study design, length of follow-up, and population characteristics. Of the 47 studies included, 16 were active cohort (Tier 1), 15 passive cohort (Tier 2), and 16 disease registry (Tier 3) studies. The overall median proportion of females reinfected with chlamydia was 13.9% (n = 38 studies). Modeled chlamydia reinfection within 12 months demonstrated peak rates of 19% to 20% at 8 to 10 months. The overall median proportion of females reinfected with gonorrhea was 11.7% (n = 17 studies). Younger age was associated with higher rates of both chlamydia and gonorrhea reinfection. High rates of reinfection with chlamydia and gonorrhea among females, along with practical considerations, warrant retesting 3 to 6 months after treatment of the initial infection. Further research should investigate effective interventions to reduce reinfection and to increase retesting.

This literature review demonstrates high rates of repeat chlamydia and gonorrhea infection among women and provides substantial evidence to support retesting 3 to 6 months after treatment.

From the *California Department of Public Health, STD Control Branch, Richmond, California; †Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; ‡Division of Infectious Diseases, Emory University, Atlanta, Georgia; and §Division of Adolescent Medicine, University of Florida College of Medicine, Jacksonville, Florida.

Supported by Centers for Disease Control and Prevention (Comprehensive STD Prevention Systems and Infertility Prevention Project Grant Number 5H25/PS904362-17) and the California Department of Public Health.

Correspondence: Heidi M. Bauer, MD, MPH, STD Control Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P, Second Floor, Richmond, CA 94804. E-mail: heidi.bauer@cdph.ca.gov.

Received for publication November 7, 2008, and accepted February 6, 2009.

© Copyright 2009 American Sexually Transmitted Diseases Association