Repeat infection with Chlamydia trachomatis following treatment is common and increases the risk of sequelae. Despite clinical guidelines recommending rescreening within 3 months of treatment, rescreening rates remain low. We undertook a systematic review to identify studies that compared rates of rescreening for repeat chlamydial infection between patients receiving and not receiving an intervention.
We searched Medline, EMBASE, and conference Web sites from 2000 to September 2010 using variations of the terms “chlamydia” and “rescreening” and “intervention.” We used meta-analysis to calculate the overall relative risk (RR) effect on rescreening rates by study design and strategy type.
We identified 8 randomized controlled trials (RCTs) and 4 controlled observational studies, all conducted in the United States. Four RCTs assessed mailed screening kits ± reminders, with an average effect estimate of 1.30 (95% confidence interval [CI]: 1.01–1.50); 2 RCTs assessed motivational interviewing ± reminders with a summary effect of 2.15 (95% CI: 0.92–3.37); one RCT evaluated the effect of reminders with a RR of 9.67 (95% CI: 1.31–71.31), and another RCT assessed the effect of a $20 patient incentive with a RR of 1.16 (95% CI: 0.62–2.17). Three controlled observational studies assessed reminder strategies with RRs of 1.97 (95% CI: 1.76–2.21), 1.01 (95% CI: 0.66–1.55), and 1.88 (95% CI: 1.58–2.24)—a summary effect was not calculated due to significant heterogeneity; and one controlled observational study assessed the promotion of clinical guidelines with a RR of 1.35 (95% CI: 0.96–1.90).
The review suggests that the use of mailed screening kits is an important strategy to increase rescreening, reminder systems are promising, and motivational interviewing is worth investigation.
From the *The Kirby Institute (formerly the National Centre in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, Australia; †Centre for Women's Health, Gender and Society, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria, Australia; ‡Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Switzerland; §Program Development and Evaluation, STD Control Branch, California Department of Public Health, Richmond, CA; ¶Department of Medicine, University of California, San Francisco, CA; and ‖Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia
Correspondence: Rebecca Guy, BAppSc, MAppEpid, PhD, The Kirby Institute (formerly the National Centre in HIV Epidemiology & Clinical Research), Faculty of Medicine, University of New South Wales, Cliffbrook Campus, 45 Beach Street, Coogee, New South Wales, 2031, Australia. E-mail: Rguy@kirby.unsw.edu.au.
Received for publication April 21, 2011, and accepted September 20, 2011.