Retesting STD after Treatment

Ever been advised by your attending physician to repeat a recent STD test after treatment? One may wonder: I have just done a recent test, and I have completed the medication antidote, do I really need a repeat test?

In this article, we explore the importance of clearance STD tests, the hindrance against such tests, and what are the implications of leaving hidden infections unaddressed. 

Test of Cure

The clearance STD test is also known as ' Test of Cure'. It serves as a confirmatory test to ensure the eradicated treatment is successful. It is usually recommended about 3-4 weeks after treatment.  However, the timing of considering a clearance test is also dependent on the type of STD, and can occasionally range even up to 3 months from the timing of treatment. Retesting involving extragenital sites may be required to ensure potential hidden infections are all screened and covered.

Need to retest for an STD after treatment? Contact DB Clinic to discuss your follow-up STD testing needs with our medical team.

Reasons One Does Not See The Need for Retesting

• I have already completed the medication prescribed

Even with completion of medication, treatment outcome may differ individually due to the body or immune system's response to the medication. Hence, some infections may persist longer, or require repeated treatment. Also, there is an increasing rise in antibiotic resistance among infections, such as the case of gonorrhea infection, requiring close monitoring and further treatment if initial treatment is unsuccessful.

• I feel fine

Most of the STDs are asymptomatic. Hence, 'feeling normal and well' does not necessarily mean that one is free from infection(s).

• My symptoms have resolved

While symptom improvement is always a positive sign that the infection is under control, as mentioned before, STDs can be asymptomatic. Laboratory evaluation remains a more accurate way to confirm clearance of infection.

• My partner did his/ her test and the result has turned normal; therefore, my results should be normal as well

Your partner's repeated tests being normal does not necessarily mean that your results are going to be normal. This is because everyone's immune system, extent of infection, and body's response to medication differ. Relying on a partner's health result to determine our own health status may not be of much prudence.

• I am too busy to repeat the test

We are living in a real world with multiple commitments from work, family, children, spouse and etc. Thankfully, there are many available and accessible clinics and hospitals that open different hours to suit your needs for scheduling an appointment.

Reasons for Retesting STD infections

• Retesting STDs ensures successful treatment and eradication of the infection

Due to increase rate of antimicrobial resistance in the world, superbugs are slowly developing due to repeated use and inappropriate dosing of antimicrobials with blind treatment. This occurs in the case of super gonorrhea. Retesting after treatment ensures effective clearance of infection, breaking the vicious cycle of spreading the infections amongst sexual partners. 

• Certain STDs have a higher risk of reinfection

Infections such as chlamydia and gonorrhea can be easily transmissible through unprotected intercourse via direct contact of body fluid. Retesting is imperative in halting the infection from passing back and forth between couple(s), resulting in treatment failures, persistent symptoms, and long-term health comorbidities.

• Missing or leaving STDs untreated can have long-term health complications

Untreated STDs can be associated with chronic inflammation and scarring of the reproductive organs of both women and men, and are associated with conditions such as pelvic inflammatory disease, chronic prostatitis or orchitis, chronic pain, and can lead to infertility.

• STDs tend to be asymptomatic, and some may have long window or incubation period 

Infections such as HSV, HIV, and HPV can have a longer incubation period before symptoms surface. Hence, being asymptomatic may not necessarily mean a person is out of the woods. One may consider following up with their doctor to repeat tests/ checkup at an appropriate time interval to pick up occult infections.

Are all STDs advisable for retesting?

• Chlamydia trachomatis
• Neisseria gonorrhea
• Trichomonas vaginalis
• Mycoplasma Genetalium
• Syphilis/ Treponema Pallidum

As some STDs may have a long incubation period, depending on individual exposure, your doctor may advise you to undergo a follow-up repeat test at an appropriate interval to ensure occult infections are not being missed.

Certain 'incurable' STDs such as Herpes Simplex Virus may not require a 'test of cure ', though your physician may offer a follow-up appointment to monitor recovery and recurring progression of the disease over time.

What are the methods used for Test of Cure for STDs?

In terms of methods used for testing: 

• These days, the laboratory uses PCR (Polymerase Chain Reaction)/ NAAT (Nucleic Acid Amplification Tests) method to process body fluid samples.
• Blood tests may be offered to monitor treat effect/ titre levels of some STDs following treatment.
• Smear tests and culture tests can still be conventionally used for microscopic evaluation of body fluid for certain STDs.

Unsure whether you need repeat STD testing after treatment? Speak with our medical team to find out what follow-up testing may be appropriate for you.

Afterwords...

Retesting rate for STDs after treatment is still below expected levels, though retesting practice is vital to ensure control of STD infections. Having a proper insight into the medical reasons for retesting STDs following treatment can improve compliance of the public in follow-up tests. If you are uncertain whether you require any follow-up tests after treatment of STDs, or unsure which type of tests or test method options, do reach out to your trusted healthcare professional for further advice.

References:

1. Craig-Kuhn MC, Granade C, Muzny CA, Van Der Pol B, Lillis R, Taylor SN, Schmidt N, Martin DH, Kissinger P. Optimal Timing for Trichomonas vaginalis Test of Cure Using Nucleic Acid Amplification Testing. Sex Transm Dis. 2019 May;46(5):312-316.
2. Wijers JNAP, van Liere GAFS, Hoebe CJPA, Cals JWL, Wolffs PFG, Dukers-Muijrers NHTM. Test of cure, retesting and extragenital testing practices for Chlamydia trachomatis and Neisseria gonorrhoeae among general practitioners in different socioeconomic status areas: A retrospective cohort study, 2011-2016. PLoS One. 2018 Mar 14;13(3):e0194351.
3. Wind CM, Schim van der Loeff MF, Unemo M, Schuurman R, van Dam AP, de Vries HJC. Test of Cure for Anogenital Gonorrhoea Using Modern RNA-Based and DNA-Based Nucleic Acid Amplification Tests: A Prospective Cohort Study. Clin Infect Dis. 2016 Jun 1;62(11):1348-1355.
4. Falk L, Enger M, Jensen JS. Time to eradication of Mycoplasma genitalium after antibiotic treatment in men and women. J Antimicrob Chemother. 2015 Nov;70(11):3134-40.
5. Hjelmevoll SO, Olsen ME, Sollid JU, Haaheim H, Melby KK, Moi H, Unemo M, Skogen V. Appropriate time for test-of-cure when diagnosing gonorrhoea with a nucleic acid amplification test. Acta Derm Venereol. 2012 May;92(3):316-9.