Objective: To systematically review and describe the evidence on chlamydia (CT) and gonorrhea (GC) re- infection among males, and to evaluate the need for re- testing recommendations in men.
Methods: We searched PubMed and STI conference abstract books from January, 1995 to October, 2006 to identify studies on CT and GC re-infection among males using CT and GC nucleic acid amplification tests or GC culture. Studies were categorized as using either active or passive follow-up methods. We calculated proportions of male CT and GC re-infection for each study and reported summary medians.
Results: Repeat CT among males had a median re- infection probability of 11.3%. Repeat GC among men had a median re-infection probability of 7.0%. Studies with active follow-up had moderate rates of CT and GC re- infection among men, with respective medians of 10.9% and 7.0%. Studies with passive follow-up had higher proportions of both CT and GC re-infections among men with respective medians of 17.4% and 8.5%. Proportions of CT and GC re-infection among men were comparable to those among women. Re-infection among men was strongly associated with previous STD history and younger age while inconsistently associated with risky sexual behavior.
Conclusions: We found substantial repeat CT and GC in men comparable to rates in women. Re-testing recommendations in men are appropriate given the high rate of re-infection. To optimize re-testing guidelines, we suggest further research to determine effective re- testing methods and establish factors associated with re- infection among males.