Repeat infection with Chlamydia and gonorrhea among females: a systematic review of the literature

Sex Transm Dis. 2009 Aug;36(8):478-89. doi: 10.1097/OLQ.0b013e3181a2a933.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Chlamydia Infections / diagnosis
  • Chlamydia Infections / epidemiology*
  • Chlamydia Infections / microbiology
  • Cohort Studies
  • Developed Countries
  • Female
  • Gonorrhea / diagnosis
  • Gonorrhea / epidemiology*
  • Gonorrhea / microbiology
  • Humans
  • Pregnancy
  • Pregnancy Complications, Infectious / diagnosis
  • Pregnancy Complications, Infectious / epidemiology*
  • Pregnancy Complications, Infectious / microbiology
  • Risk Factors
  • Time Factors
  • United States / epidemiology
  • Women's Health*
  • Young Adult