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Clinician education, advice and SMS/text reminders improve test of reinfection rates following diagnosis of Chlamydia trachomatis or Neisseria gonorrhoeae: before and after study in primary care
  1. Sally B Rose1,
  2. Susan M Garrett1,
  3. Deborah Hutchings2,
  4. Kim Lund2,
  5. Jane Kennedy2,
  6. Susan R H Pullon1
  1. 1 Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
  2. 2 Wellington Sexual Health Service, Wellington, New Zealand
  1. Correspondence to Dr Sally B Rose,Primary Health Care and General Practice, University of Otago, Wellington, New Zealand; sally.rose{at}


Background Evidence-based guidelines for the management of Chlamydia trachomatis and Neisseria gonorrhoeae recommend testing for reinfection 3–6 months following treatment, but retesting rates are typically low.

Methods Participants included six primary care clinics taking part in a pilot study of strategies designed to improve partner notification, follow-up and testing for reinfection. Rates of retesting between 6 weeks and 6 months of a positive chlamydia or gonorrhoea diagnosis were compared across two time periods: (1) a historical control period (no systematic approach to retesting) and (2) during an intervention period involving clinician education, patient advice about reinfection risk reduction and retesting, and short messaging service/text reminders sent 2–3 months post-treatment inviting return for retesting. Retesting was calculated for demographic subgroups (reported with 95% CI).

Results Overall 25.4% (61 of 240, 95% CI 20.0 to 31.4) were retested during the control period and 47.9% (116 of 242, 95% CI 43.2 to 55.1) during the intervention period. Retesting rates increased across most demographic groups, with at least twofold increases observed for men, those aged 20–29 years old, and Māori and Pasifika ethnic groups. No significant difference was observed in repeat positivity rates for the two time periods, 18% (11 of 61) retested positive during the control and 16.4% (19 of 116) during the intervention period (p>0.05).

Conclusions Clinician and patient information about retesting and a more systematic approach to follow-up resulted in significant increases in proportions tested for reinfection within 6 months. These simple strategies could readily be implemented into primary healthcare settings to address low rates of retesting for bacterial sexually transmitted infections.

Trial registration number ACTRN12616000837426.

  • sexually transmitted infections
  • chlamydia
  • gonorrhoea
  • primary health care
  • service delivery
  • reinfection

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  • Contributors All authors were involved in the design and conduct of the research. SBR led the study, participating in collation, analysis and interpretation of the data, and drafted the manuscript. SMG participated in project management, cleaning, collation and analysis of data, and revision of the manuscript. DH, KL, JK and SRHP participated in the interpretation of results and revision of the manuscript. All authors read and approved the final manuscript prior to submission.

  • Funding This study was funded by a Lottery Health Research Grant, a University of Otago Wellington Dean’s Grant and a grant-in-aid from ISTAR.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Southern Health and Disability Ethics Committee (New Zealand) granted approval for baseline data collection (16 July 2015, 15/STH/109), and the Central Health and Disability Ethics Committee granted approval for the intervention study (1 April 2016, 16/CEN/38).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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